ACUTE CASES 
IN MOR^t MEDICINE 



REV: EDWARD R BURKE 




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COPffilGHT DEPOSIT. 



ACUTE CASES IN 
MORAL MEDICINE 



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THE MACMILLAN COMPANY 

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ACUTE CASES IN 
MORAL MEDICINE 



BY THE REVEREND 
EDWARD F. BURKE, M.A., Ph.D. 

PROFESSOR OF THEOLOGY, ST. MARY S SEMINARY, 
CLEVELAND 



&tto gotfc 

THE MACMILLAN COMPANY 
1922 

All rights reserved 



^BX /76"f 

PRINTED IN THE UNITED STATES OE AMERICA 



Copyright, 1922, 
By THE MACMILLAN COMPANY. 



Set up and electrotyped. Published October, 1922. 



Press of 

J. J. Little & Ives Company 

New York, U. S. A. 



OCT 18 '22 

?)CH686366 



To that love of God and man, which in- 
spires the doctor and the nurse, the sister 
and the priest to deeds of untiring zeal and 
heroic self-sacrifice, this book is respectfully 
dedicated. 



NIHIL OBSTAT 

T. C. O'Keilly, S.T.D., 
Censor Deputatus 

IMPKIMATUR 

IJIJOSEPHUS SCHREMBS, 

Episcopus Clevelandensis 
Cleveland, Ohio, March 25, 1922 



FOREWORD 

The trained nurse holds a position of 
highest (rust and responsibility in the 
professional world of to-day. 

She (Miters our homes at a most crit- 
ical time when the lives of our loved ones 
hang in the balance. 

Her responsibilities involve loyalty to 
the physician or surgeon, faithful and 
devoted care of the patient, the utmost 
regard tor the sacredness of the home 
and its intimate relations and confi- 
dences, and absolute fidelity to her own 

conscience. 

This fourfold relationship demands a 

correct knowledge of the sacred prin- 
ciples of sound morality and the consci- 
entious application thereof to the daily 

tasks o\' the trained nurse. 

The truest measure of her service to 



X FOREWORD 

humanity will ever be found in her fidel- 
ity to her conscience and to the sacred 
laws of God. 

The real value of the present publica- 
tion lies in its splendid presentation of 
the fundamental principles of Christian 
morality bearing on the duties of the 
trained nurse. 

The author has accomplished his task 
in a most admirable manner, and I take 
pleasure in recommending this book as 
a text for our schools of nursing. 

^ Joseph Schrembs 
Bishop of Cleveland 



INTRODUCTION 

Those whose duty it is to care for the 
sick, doctors, nurses and others, are 
called upon frequently to meet perplex- 
ing emergencies. 

It is the purpose of this book to mark 
out a safe line of conduct, brief and 
readily accessible in those ever-recur- 
ring cases in which the rights of others 
are directly concerned. 

Man's rights are two-fold, temporal 
and spiritual, corresponding to the two- 
fold order of which he is a being. The 
foundation of his temporal rights is his 
right to life; chief among his spiritual 
rights is the right of religion. It is with 
certain phases of these two rights that 
this treatise deals. 

The treatment naturally falls into two 
distinct parts. The first part concerns 



Xll INTRODUCTION 

itself with the respective rights of the 
mother and her unborn child, adding 
under the caption "Special Cases" cer- 
tain ethical directions on matters of 
practical moment. The second part, 
assuming the recognition of our duty to 
those in dire need of spiritual help, 
treats of the ways in which this help 
may be accorded. 

In neither part is there any attempt 
at argumentation; there is, however, 
ample reference to authoritative works 
which discuss at length the conclusions 
based upon established principles. The 
aim throughout has been to give a defi- 
nite answer to difficulties and in every 
instance the conclusion herein accepted 
in response to a moot question, is in 
accord with solid principles of morality, 
often the embodiment of a positive 
divine enactment, and, not infrequently, 
the decisive expression of the Sacred 
Congregation of the Holy Office. 



CONTENTS 

PAGE 

I. Temporal Rights — Life 1 

1. Principles 3 

2. Application 20 

I. Embryotomy 20 

II. Abortion 21 

A. direct 25 

B. indirect 28 

(1) medical treatment 33 

(2) operative treatment .... 34 

(A) not involving uterine con- 

tents 35 

(B) involving uterine contents 36 

(C) tumors of the womb . . 42 

III. Ectopic Gestation 48 

IV. Special Cases 54 

1. Euthanasia 54 

2. Twilight Sleep 55 

3. Illicit Operations 57 

4. Co-operation 60 

5. Race Suicide 62 

6. Professional Consultation 63 

II. Spiritual Rights — Religion 65 

A. Baptism of Necessity 67 

xiii 



XIV CONTENTS 

PAGE 

I. Principles 67 

II. Application 75 

A. Adults . . 75 

1. conscious 75 

2. unconscious 78 

3. demented 79 

4. comatose 80 

B. Infants 81 

1. no sign of life 81 

2. premature birth 82 

3. difficult parturition 85 

4. children of non-Catholics ... 88 

5. foundlings ........ 88 

6. abnormalities 89 

7. unborn, and mothers dead, dying, 

and sick 97 

B. Last Sacraments 101 

C. Christian Burial 107 

General Conclusion 109 

Appendix I. — Decrees of the Holy Office . . . Ill 

Appendix II. — Suggestions 113 

Glossary 117 

Bibliography 123 

Index ......... . ; 125 



PAET I 

TEMPORAL EIGHTS 

LIFE 

ITS SOURCES AND 

SAFEGUARDS 

Since we are all of a common clay, it behooves us 
to assist our brethren of the dust in their needs to 
the end that disease and suffering be forestalled 
and prevented, health and happiness restored, and 
the divine spark preserved in its fragile tenement. 
We are our brother's keeper. 



ACUTE CASES IN MORAL 
MEDICINE 

1. Establishment of Principles 

This book assumes the existence of Postulates. 

God, Creator and Supreme Legislator, 

without Whom there can be no authority, 

no law. It assumes the freedom of the 

human will, without which there can be 

no responsibility, no imputability. It 

assumes an essential difference between 

right and wrong. Irrespective of any 

human law or positive divine enactment 

certain actions are intrinsically and of 

their very nature morally good, others 

intrinsically and of their very nature 

morally bad, so that if the former came 

under no command, the latter under no 

prohibition, the former would, neverthe- 
3 



4 ACUTE CASES IN MORAL MEDICINE 

less, be morally right, the latter, mor- 
ally wrong. Without this distinction 
there can be no true basis for morality, 
radically there can be no true ground 
for coercion or punishment. 
God's The nature of the morally good and 

Design. J & 

the morally evil we shall not discuss, nor 
shall we speak at length of what consti- 
tutes the standard of judgment — the 
norm of morality. Suffice it to say that 
God in His Infinite Power has absolute 
dominion over all creatures, that in His 
Infinite Wisdom He has appointed to 
them certain ends and has endowed 
them with means proper to the attain- 
ment of those ends. This is the Eternal 
Law: — "the plan of government in the 
mind of God according to which He 
has eternally decreed to guide all things 
and direct them to their final goal." 
According to this decree, each creature 
is directed along a definite line of action 
in keeping with its nature, irrational 
beings by physical necessity, those en- 



TEMPORAL, RIGHTS O 

dowed with intelligence and free will, 
by moral obligation. As man is an intel- 
lectual creature, endowed with freedom 
of choice, God directs him, not by phys- 
ical necessity, not as He directs the 
planet in its course and the brute by its 
instinct, but by the Natural Law, by 
"the participation of the Eternal Law in 
a rational creature," by the knowledge 
of the Eternal Law and its obligations — 
by a moral necessity. Whatever befits 
man as a rational being is good, the 
Natural Law commands it. What ill 
befits him as a rational being is evil, the 
Natural Law forbids it. Do good and 
avoid evil, is the basic principle of 
morality. 

In virtue, then, of the Natural Law, ^f^f 6 of 

7 y J Right. 

which arises immediately from the rela- 
tion between Creator and creature, man 
stands possessed of certain rights. By 
the very fact of his rational nature he is 
endowed with an inviolable moral power 
of having, acquiring, or doing some- 



O ACUTE CASES IN MORAL MEDICINE 

thing. This power is moral because its 
exercise is in accord with the rational 
nature of man; it is inviolable because 
simultaneous with the origin of right in 
one, arises in all others the duty to re- 
spect that right. 
Right to The object of right — the things which 

a man has the moral power to possess, 
acquire, or do, are the means the Creator 
has given man to attain his end. Chief 
among these is his right to life. It is 
connatural because it belongs to man by 
his very nature ; it is moral because he 
possesses it in virtue of eternal decrees ; 
it is inviolable because there is a boun- 
den duty to respect it. And this duty 
binds every individual man, for while he 
has the right to preserve and enjoy his 
life, he has not the right of ownership 
in his life and cannot dispossess himself 
of it. And if no man may take his own 
life, for a stronger reason no other may; 
in his mere private capacity my fel- 
lowman in regard to my life has 



TEMPORAL RIGHTS i 

right neither of benefit nor of owner- 
ship. 

And yet the right to life is not abso- *JJJf£- of 
luteiy inalienable. A man may forfeit Life * 
it. There are crimes which call for blood 
punishment. The State may remove the 
member which threatens the soundness 
of its social life. The individual in 
blameless self-defense may meet vio- 
lence with violence, that is to say, in case 
of unjust aggression, the rights of the 
aggressor, by the very act of aggression, 
are temporarily suspended and he him- 
self placed in juridic inferiority to the 
rights of the one attacked. 

The right of the State to levy on its 
own manpower and compel its citizens 
to risk their lives in its just defense is 
conceded. Conceded, too, is the right of 
mortal risk to individual life in the dis- 
charge of public duty, nay, even in a 
private capacity in the interests of 
science or where a great good is to be 
obtained. 



8 ACUTE CASES IN MORAL MEDICINE 

The principles enunciated in the Dec- 
laration of Independence are in strict 
accord with this doctrine: "We hold 
these truths to be self-evident, that all 
men are created equal; that all are en- 
dowed by their Creator with certain in- 
alienable rights; that among these are 
life, liberty, and the pursuit of happi- 
ness.' ' In framing that immortal Char- 
ter the Fathers of our country would 
have us understand that where there is 
question of direct killing of an innocent 
person, life is strictly inalienable; that 
the innocent stands in full possession of 
his God-given rights, and so sacred are 
they that not even public authority can 
authorize their deprivation. And the 
reason is, life destruction assumes abso- 
lute mastery; it is therefore an infringe- 
ment on the dominion which God alone 
possesses. Nor is this all. The Foun- 
ders of our Liberty would have us note 
a still further sense in which there is an 
element of inalienability associated with 



Child. 



TEMPORAL BIGHTS 9 

human life, namely, that there are cer- 
tain rights conditioned upon the inviola- 
bility of life, particularly the right to 
worship God and the right to eternal 
salvation, of which no power on earth 
can rob us. 

The Right to Life, then, is natural, 
moral, inviolable, intrinsically inalien- 
able, unassailable and God-given. 

In the practice of their profession Life of 

Mother and 

doctors and nurses often meet what 5^° m 
many are pleased to style a "Conflict 
of Rights ' ' ; a precise case would be the 
right to life between the mother and the 
unborn child. From the standpoint 
sometimes adopted by medical science, 
theoretically the right of the child must 
give way before that of the mother, if 
the destruction of the child becomes 
necessary to save the mother's life, and 
practically, there are cases in which 
embryotomy, abortion, and the removal 
of an inviable ectopic fetus are, they say, 
positively indicated. 



10 ACUTE CASES IN MORAL MEDICINE 

view^of From the standpoint of moral science 

science. there may be a conflict of claims, but a 
conflict of rights is a contradiction. As 
regards the case in question, that, viz., 
of the mother and the unborn child, the 
answer of moral science is in direct 
opposition to the answer given by some 
members of the medical profession. Bas- 
ing its claim upon the conclusions of 
biology and psychology, moral science 
teaches that the right to life begins at 
the moment of conception, at the moment 
the spermatozoon penetrates the ovum 
and they become one fusion principle 
acting with an independent life. From 
then on the life within the womb de- 
serves the same consideration as life 
outside the womb. The life of the child 
is to be safeguarded equally with the life 
of the mother ; to attack either is crim- 
inal. There is no question here of pref- 
erence, there may be no balancing of 
importance; it is not a point for medi- 
cine to decide or statute to determine; 



TEMPORAL RIGHTS 11 

it is strictly within the domain of right 
and duty; it is a matter of the natural 
law and, therefore, must be judged in 
accord with moral principles. The great 
moral principle governing the case is : — 
each is a human being, each is innocent, 
each has rights ; it is morally wrong to 
attack either directly in order to assist 
the other indirectly ; death from natural 
causes is one thing, so-called therapeutic 
death, quite another. You are never al- 
lowed to do evil that good may come 
from it — a dictate of reason which the 
word of God confirms. Hence, no matter 
the treatment said to be indicated, itj£ 
never permissible to kill the fetus to 
save the mother. The direct termina- 
tion of fetal life can never be justified. 
It should be noted here that insistence 
is to be placed upon the words " direct 
termination of fetal life," for, as will be 
shown in the discussion on abortion, 
there is a termination of fetal life, re- 
sulting from medical or surgical pro- 



12 ACUTE CASES IN MORAL MEDICINE 

cedures which may be absolutely without 
blame. At this juncture, however, a 
word on the general principles under- 
lying direct and indirect killing does not 
seem out of place. 

An action takes its moral color from 
three constituents, the object, the end, 
and the circumstances: 

rfSonS 8- ( a ) ^^£ object is the deed performed, 
Diagnosis. ^he thing done, e.g., to pray, to 

steal, to walk. 

(b) The end is the reason why the 
deed is performed, the thing is 
done; it is the intention of the 
agent, e.g., praying to honor God, 
stealing to obtain money for 
drink, walking to cure insomnia. 

(c) The circumstances are the various 
conditions which accompany the 
action, increasing or lessening, or 
changing the moral color which it 
already has from the object and 
the intention of the agent; e.g., 



TEMPORAL RIGHTS 13 

to steal from a poor widow is a 
greater crime than to steal the 
same amount from a millionaire 
miser; were a son to kill his 
father he would be guilty not only 
of the ordinary kind of murder 
but of that specific type called 
parricide. 

Now, that a concrete action be morally 
good, it must be good in all its constitu- 
ents, object, end, and circumstances; if 
any one of these elements is bad, the act 
is vitiated and at once becomes morally 
wrong. To sleep is good, but for a sen- 
try to sleep while on duty merits court- 
martial. To assist the poor may be a 
worthy act of charity, but to steal in 
order to do so is surely stepping beyond 
the sphere of strict right. To pray, as 
did the Pharisees, that you may be seen 
and praised by men, is certainly a waste 
of time and hypocritical to boot. From 
this it can be readily seen that a bad 



14 ACUTE CASES IN MORAL MEDICINE 

intention can vitiate an act otherwise 
morally good, and, too, that no matter 
how praiseworthy and noble an end may 
be, it can never justify an evil means. 
Responsi- Further, it is one thing to set forth the 

principles of moral diagnosis and quite 
another to say that an action is impu- 
table to a man as its author, that he is 
responsible for it and its consequences. 
Knowledge and freedom are necessary 
prerequisites for imputability, but they 
are not the only essentials; the action 
must also be voluntary, that is, it must 
proceed from the will; it may proceed 
from the will in one of two ways, directly 
or indirectly. 

(a) An action proceeds from the will 
directly when it is performed either for 
itself alone or as a means to something 
further. 

( b) An action proceeds from the will 
indirectly when it follows as a foreseen 
result from another action willed di- 
rectly, either as an end or as a means. 



TEMPORAL RIGHTS 15 

Since no one should ever have occa- 
sion to regret the unmixed good he does, 
reference is made whenever there is 
question of imputability to an action bad 
in itself or in its consequences. If the 
action is bad in itself (in its object, end, 
or circumstances), be it a means or an 
end, there can be no doubt of the imputa- 
bility of wrong to the agent and conse- 
quently of his responsibility. Should a 
man extremely desirous of amassing 
wealth, steal to amass it, theft is the 
object and there the action rests; but 
were he convinced he could amass more 
by gambling and then steal in order to 
gamble, gambling would be the end, theft 
the means. In the first case the stealing 
is directly voluntary, in the second case 
both the stealing and the gambling are 
directly voluntary. In each case the 
action is imputable to the man as its 
author and he is responsible, in the 
former instance for one, in the latter for 
two specific infractions. If, however, 



16 ACUTE CASES IN MORAL MEDICINE 

the action is not bad in itself, but good 
(in object, end, and circumstances) and 
the agent directly intends it alone, but 
foresees that, were it performed, evil 
consequences would result, is he obliged 
to refrain from performing the good 
action on account of those evil conse- 
quences? In other words, granted that 
he may never approve, is he ever allowed 
to tolerate or permit a moral or physical 
evil? Is he allowed to perform an 
action from which he foresees that be- 
sides the good, an evil effect will also 
follow? 

Eecalling the principles already given, 
let us submit the matter to analysis : 

If (1) the action viewed in itself is 
good, or indifferent; 

if (2) the agent intends only the 
good; 

if (3) the evil is not the means to the 
good but results from the same 
cause as the good, then evi- 



TEMPORAL RIGHTS 17 

dently the only obstacle to the 
action would be the absence of 

(4) a sufficiently grave reason for 
permitting the evil. 

The other conditions, then, being ^concrete 
present, if the good effect is equal to or 
greater than the evil effect, the action 
may be performed without blame; if, 
however, the good effect were not at 
least equal to the evil effect, the per- 
formance of the action would be wrong 
and blameworthy. When, therefore, in 
a concrete case the solution resolves 
itself down to a question of proportion 
between the good and the evil, it is a 
matter of keeping things in their proper 
sphere and applying sane judgment. 
Take a concrete case. "Suppose a per- 
son whose clothes have caught fire jumps 
into a lake to extinguish the blaze. The 
fire is extinguished but incidentally the 
person drowns. Is he guilty of suicide? 



18 ACUTE CASES IN MORAL MEDICINE 

No, because all the conditions enumer- 
ated are present: 

(1) The action of jumping into the 
lake was in itself indifferent; 

(2) The agent did not intend the 
drowning, but the extinguishing 
of the fire ; 

(3) The good effect — putting out the 
fire — is not caused by the drown- 
ing; 

(4) There was a sufficient reason to 
justify the action, namely, the 
avoiding of the agony of death by 
fire." (Ross: "Ethics," p. 19.) 

When, therefore, it is said that indirect 
killing may sometimes be licit, it is 
meant that under certain conditions it 
may be tolerated as a consequence 
within the knowledge but not the inten- 
tion of an agent, from an action which 
it was lawful for him to perform. And, 
as we shall see later, this is what is 



TEMPORAL RIGHTS 19 

meant by the indirect termination of 
fetal life. 

To recapitulate: 

(1) It is never allowed to perform an 
action, the direct and only conse- 
quence of which is wrong — we 
must do good and avoid evil. 

(2) It is never allowed to perform an 
action, the direct consequence of 
which is wrong though that con- 
sequence in turn is the means to 
a far surpassing good result — the 
end does not justify the means. 

(3) Under certain conditions it is al- 
lowed to perform an action from 
which a two-fold effect follows, 
one good, the other evil. 

Thus far the principles. 



2. Application of Principles 



Embryotomy 

Definition. Embryotomy is the cut- 
ting of a fetus to facilitate delivery. 

Species. Embryotomy comprises all 
those operations whose purpose is the 
dismemberment of the fetus to reduce 
the bulk, such as craniotomy, cephalo- 
tripsy, cephalotomy, embryulcia, evis- 
ceration. 

Morality. Embryotomy is never per- 
missible upon a living fetus. It is an 
operation directly against the right to 
life, the command: "Thou shalt not 
kill. ' ' In the words of the late lamented 
giant in medicine, Dr. John Murphy, "it 
is scientifically unjustifiable, — a blunder 

in surgery." While there is no pro- 
20 



TEMPORAL RIGHTS 21 

hibition of embryotomy upon a dead 
fetus, yet the presence of life must be 
presumed till the fact of death has been 
duly established. And positive evidence 
is required. Each case demands com- 
petent consultation. 

ii 

Abortion 

Definition. Abortion is the expulsion 
of the fetus before it is viable — before 
it is sufficiently developed to continue its 
life outside the maternal womb. 

A word here on viability and the in- 
duction of premature labor will not be 
out of place. Dr. Austin O'Malley in 
his work, * ' The Ethics of Medical Homi- 
cide and Mutilation," page 56, says: 
"A full seven-months infant may be 
reared with proper feeding and skilled 
care ; a six-months infant may be reared 
(with difficulty) in a hospital, with 
skilled care." With this view Professor 



22 ACUTE CASES IN MORAL MEDICINE 

Williams, of Johns Hopkins, is in al- 
most literal agreement. By the word 
"months" Dr. O'Malley means calendar 
or solar, not lunar, months. The prac- 
tical conclusion is that with the most 
skilled care fetal life may not be ter- 
minated before the twenty-sixth week of 
gestation, and where only average care 
is to be had, not before the thirtieth 
week. Later, in the same chapter, that 
eminent authority adds a further con- 
sideration, namely, that owing to the 
diseased condition of the mother, often 
a six-month fetus in age is really not so 
in development. The period, then, of 
arrival at viability is somewhat relative, 
and each case must be considered to- 
gether with the attendant circumstances. 
Further, while viability is in the primary 
condition for the acceleration of birth, 
it is not the only requisite; it is neces- 
sary, besides, that there be a just and 
grave reason for the interruption of 
pregnancy and that the method em- 



TEMPOKAL EIGHTS 23 

ployed be not ordinarily fatal to either 
mother or child. 

Species. It is necessary to view abor- 
tion from the standpoint of both medical 
and moral science. 

A. Medical Science distinguishes 
abortion into accidental — that 
which is due to accident, — and 
artificial or induced — that which 
is brought on purposely ; and fur- 
ther, it divides artificial abortion 
into criminal and therapeutic; 
criminal abortion it styles that 
which is unnecessary for thera- 
peutic reasons and therefore un- 
justifiable ; therapeutic abortion 
it terms that which is induced to 
save the life of the mother, and 
because of this some practitioners 
claim it is justifiable. 

B. Moral Science distinguishes arti- 
ficial abortion into direct and in- 
direct : 



24 ACUTE CASES IN MORAL MEDICINE 

Direct abortion is that in which 
the fetus is the object of attack- 
that is, when the intention is to 
remove the inviable fetus or when 
the means employed tend pri- 
marily by their very nature to the 
removal of it. "It is the imme- 
diate end of the invasion of the 
pregnant womb, ' ' the natural and 
necessary result of the means 
employed. 

Indirect abortion is that which 
occurs when the fetus is in no 
wise the object of attack — that is, 
when the abortion results as a 
secondary and unintentional con- 
sequence from means which by 
their very nature tend immedi- 
ately to effect the cure of the 
mother, and only remotely en- 
danger the fetus. In direct abor- 
tion, the abortion itself is the 
means to the cure; in indirect 
abortion, the cure is independent 



TEMPORAL RIGHTS 25 

of the removal of the fetus, and 
the abortion, if it occurs, is a 
secondary consequence of the 
treatment. 

Morality. Moral science does not ad- 
mit the distinction of abortion into crim- 
inal and therapeutic, made by medical 
science; on the contrary, it expressly 
teaches that you are never allowed to do 
evil that good may result. A humani- 
tarian motive, a lofty purpose, profes- 
sional confirmation, statutory acquies- 
cence, neither singly nor in combination, 
can render an evil act morally good. In 
pursuance of its distinction of abortion 
into direct and indirect abortion, moral 
science enunciates two principles: 

A. Direct abortion, be it criminal or ?i rec * 

' Abortion. 

therapeutic, is never permissible upon a 
living fetus. It is a violation of the laws 
of nature, the rights of the individual, 
and the command of God ; it is the direct 
killing of an innocent person and, there- 



26 ACUTE CASES IN MORAL MEDICINE 

fore, murder. There are no exonerating 
circumstances. Moral science unhesi- 
tatingly brands as murder the perform- 
ance of therapeutic abortion in each 
and every case in which the medical pro- 
fession has taught its indication; even 
the most serious conditions of pregnancy 
furnish no exception. Moral science ad- 
mits of no treatment, medicine or opera- 
tion, whose purpose directly and of its 
very nature is to attack the inviable 
fetus. Hence, there must be no artificial 
disturbance of pregnancy — 

(1) In the toxemias of pregnancy, as 
pernicious vomiting, eclampsia, 
nephritis, acute yellow atrophy of 
the liver; 

(2) In acute or chronic infectious dis- 
eases, as pneumonia, influenza, 
typhoid, tuberculosis, malaria, 
chorea ; 

(3) In those diseases which it is 
claimed pregnancy aggravates, as 



TEMPORAL RIGHTS 27 

diabetes, heart disease, pyelitis, 
pernicious anemia; 

(4) In case of contracted pelvis or any 
pelvic malformation. 

While the artificial abortion in these or 
similar cases is illicit or immoral, yet 
the condition of the mother may be such 
as to warrant premature delivery or the 
caesarean section, provided the child is 
viable. 

It should not be necessary to mention 
that there must be no curettement of the 
pregnant uterus or during pregnancy 
any dilatation of the os uteri ; care, too, 
must be taken that the expectant mother 
be not subjected to a general anesthetic 
or to X-ray photography except under 
grave necessity. 

In this connection it may be well to 
mention that the mother, irrespective of 
any professional treatment, has certain 
duties: she may take no oxytocic drug 
or emmenagogue, engage in no violent 



28 ACUTE CASES IN MORAL MEDICINE 

exercise, perform no heavy labor with 
the intent of affecting the pregnancy. 
And, too, her diet and clothing should be 
in conformity with her condition. 

Under no circumstance, then, may a 
living, inviable fetus be expelled from 
the womb. As a therapeutic measure, 
direct abortion is the doing of evil that 
good may result; it is the assuming of 
mastery over innocent life; it is, there- 
fore, morally wrong, unjustifiable, and 
absolutely criminal. 

But the mother, too, has rights, and 
while the fetus may never be attacked 
directly, no matter what the benefit ac- 
cruing to the mother, it may at times be 
wholly within the domain of right, in 
fact morally imperative, to provide for 
the cure of the mother even at the risk 
of abortion. This accounts for the sec- 
ond principle of moral science, that on 
indirect abortion, 
indirect B. Indirect abortion may sometimes 

Abortion. " 

be licit morally; while the direct termi- 



TEMPORAL BIGHTS 29 

nation of fetal life is never permissible, 
its indirect termination is not always 
wrong. Under certain circumstances it 
is allowed to administer a drug or to 
perform a treatment from which as a 
secondary and unintentional result abor- 
tion may ensue. 

The reason for this principle is 
founded on the moral fact that one is not 
always prohibited from performing an 
action in itself not bad, but good, or at 
least indifferent, from which a twofold 
effect follows. Eecall here the prin- 
ciples on indirect killing together with 
the illustration — the person whose cloth- 
ing has caught fire jumping into a lake. 
In like manner apply those principles to 
the work of a policeman, an electrician, 
a structural iron-worker, a painter, a 
chemist — occupations which carry with 
them constantly the risk of sudden 
demise, yet no one maintains it is mor- 
ally wrong to engage in (hem. No one 
will deny it is perfectly licit to admin- 



30 ACUTE CASES IN MORAL MEDICINE 

ister a general anesthetic for an opera- 
tion even slightly serious. Take a 
specific case. Suppose your friend has 
been stricken with cholera and the only 
remedy at hand is liquor. You insist 
upon his taking an enormous quantity; 
as a result he becomes stupidly drunk, 
but the poison is counteracted, the dis- 
ease checked, and his life saved; now — 

(1) The object, the giving of liquor, 
is indifferent; 

(2) The intention, the saving of his 
life, is good ; 

(3) Both the good effect, the saving 
of his life, and the evil effect, the 
drunken stupor, follow equally 
and immediately from the same 
action, the giving of the liquor, — 
the evil effect is not the cause of 
the good effect; 

(4) There is a sufficiently grave rea- 
son ; surely no one would hold you 
morally blameworthy. 



TEMPORAL RIGHTS 31 

In like manner, indirectly imperiling 
the life of the fetus is sometimes per- 
mitted. There are, however, conditions 
governing the case and only when they 
are verified may the fetal life be jeopar- 
dized. Imperiling the life of the child 
is serious, and only the grave condition 
of the mother would furnish a reason 
sufficiently good and proportionate to 
warrant its being endangered; and the 
treatment itself, though it has the ten- 
dency to dislodge the fetus, must be such 
as to be effective independently of any 
connection with the fetus ; finally, in no 
case may the expulsion of the fetus be 
the object aimed at. The situation may 
be analyzed as follows: 

(1) A crisis in the mother which calls 
for extreme treatment. 

(2) A treatment, medicine or opera- 
tion, which has a double effect : 

a. One good, the cure of the 
mother, willed; 



32 ACUTE CASES IN MORAL MEDICINE 

b. One evil, the expulsion of 
the fetus, reluctantly per- 
mitted. 

(3) The evil effect is not the means to 
the good, but follows from the 
same cause, — medicine or opera- 
tion. 

(4) The crisis in the mother is a suffi- 
ciently grave reason. 

While, then, no means, general or spe- 
cial, may be employed with the view of 
terminating the pregnancy, yet with 
those conditions verified, no ethicist can 
hold a doctor, nurse or mother morally 
responsible for the abortion which may 
ensue; for it cannot be denied that in 
safeguarding her life the mother has a 
certain right to the use of all good means 
which do not first and directly attack the 
equally important rights of others. 

Though this principle is clear enough 
in theory, the practical application 
creates a difficulty — and medicine and 



TEMPORAL RIGHTS 33 

surgery concern themselves with con- 
crete cases. Hence, to render a practical 
judgment easier, it may not be amiss to 
treat the matter under the following 
headings: (1) Conditions Indicating 
Medical Treatment; (2) Conditions In- 
dicating Operative Treatment. 

First, Conditions Indicating Medical £**££ t 
Treatment. A question may place this 
matter in a clearer light : Is a physician 
permitted to administer a certain medi- 
cine needful for the mother if he fore- 
sees it is liable to induce abortion? In 
answering, distinction must be made be- 
tween the necessity and the utility of the 
medicine on the one hand, and its lia- 
bility to induce abortion on the other. 
If the medicine is necessary to save the 
life of the mother, it is permissible to 
give it, irrespective of the abortion 
which may ensue; further, even though 
it is not necessary but very useful to the 
mother, it is permissible to give it, pro- 
viding the danger to the child is very 



3i ACUTE CASES IN MORAL MEDICINE 

slight; if, however, the danger to the 
child overbalances the usefulness to the 
mother, it is morally wrong to admin- 
ister the medicine. With these distinc- 
tions in mind it is readily seen that in 
threatened abortion the cautious use of 
morphin for the relief of uterine irrita- 
bility is morally permissible despite its 
narcotizing properties. Quinin in large 
doses (even in small doses frequently 
repeated) is decidedly oxytocic, yet in 
accordance with the principles estab- 
lished, there is nothing against its use 
as a specific in malaria, or as an anti- 
pyretic as, e.g., in grippe and influenza. 
It follows as a corollary, which scarcely 
needs mention, that when medical treat- 
ment is imperative, and there is a choice 
of remedies equally beneficial to the 
mother, the physician is morally obli- 
gated to administer the one less danger- 
ous to the child, 
surgical Second, Conditions Indicating Opera- 

tive Treatment. Although as a general 



Treatment. 



TEMPORAL RIGHTS 35 

rule it is advisable, unless grave neces- 
sity intervenes, to defer all operative 
procedures until after delivery, yet 
when in the course of pregnancy condi- 
tions arise, in which to the best judg- 
ment of the conscientious and capable 
surgeon, operative treatment is indi- 
cated, the necessary operation is morally 
licit provided the fetus be not thereby 
directly attacked. 

(A) When the operation deemed 
imperative is remedial of a condition 
unconnected with the pregnancy , its 
licitness is readily understood from the 
general principles. Hence, there need 
be no hesitancy in operating for: 

(1) The cure of such conditions as 
acute appendicitis, diseased kid- 
ney, intestinal obstruction, cancer 
of the stomach or breast, chole- 
cystitis, strangulated hernia. 

(2) The cure of the uterine adnexa 
menacingly diseased, as ovarian 



36 ACUTE CASES IN MORAL MEDICINE 

or tubal tumors, and this to the 
extent of the removal of the 
ovaries and tubes themselves if, 
in accord with the best diagnostic 
judgment, their condition de- 
mands removal. (See Special 
Cases, 3.) 

(3) Eeposition in uterine displace- 
ments, especially in case of in- 
carceration. 

(B) When, however, the uterine con- 
tents come under operative considera- 
tion, the matter presents a more difficult 
angle and the line betiveen what is right 
and what is wrong is more delicately 
drawn. Among the conditions which 
evoke special moral interest, threatened 
abortion, placenta praevia, premature 
separation of the placenta, rupture of 
the uterus, and disease of the ovum, are 
among the most common. 

Threatened (1) In threatened abortion, all possible 

Abortion. 

means must be employed to save 



TEMPORAL RIGHTS 37 

the fetus; only when the hemor- 
rhage has become so profuse that 
the woman 's life is endangered and 
the abortion inevitable, is packing 
morally licit. Under no circum- 
stance may curettage be employed 
as a remedy in threatened abor- 
tion. It would be the direct de- 
struction of innocent life. How- 
ever, once the ovum has been ex- 
pelled curettage is morally licit. 

(2) In placenta praevia— the develop- placenta 
ment of the placenta so that it en- 
croaches upon or covers the in- 
ternal os — if the child is viable, the 
induction of premature labor or the 
csesarean section is morally per- 
missible ; if the child is not viable, 
then, again, all possible means 
must be employed to save it ; pack- 
ing is allowed only when the woman 

is bleeding to the risk of her life. 

(3) In premature separation of the pla- gj 6 ™*^}™ 
centa the method of treatment de- of Placeuta 



38 ACUTE CASES IN MORAL MEDICINE 

pends upon whether the placenta 
has been completely or only par- 
tially detached from the uterine 
wall. If the separation is but par- 
tial, the accident may be without 
serious significance ; interference 
is morally licit only when symp- 
toms become gravely urgent. If, 
however, the separation is com- 
plete, then it is necessary to begin 
delivery at once, no matter what 
be the stage of fetal development. 
The moral aspect is clear, for, 
technically, the abortion has actu- 
ally taken place ; it was effected by 
accident which caused the separa- 
tion. The utmost haste is impera- 
tive if the child is to be saved for 
Baptism. 
Rupture of (4) In rupture of the uterus several 

Uterus. v ' x 

moral phases are presented. If 
the fetus is dead the skillful ob- 
stetrician will meet the situation in 
accord with the exigencies of the 



TEMPORAL RIGHTS 39 

case. If the fetus is alive and 
viable, whether it is still within the 
uterus or has already escaped into 
the abdominal cavity, laparotomy 
is performed, the child extracted 
and the demands of the case met 
with the necessary operative pro- 
cedures. If the fetus is alive and 
inviable, it must not be attacked 
directly; if necessary to prevent 
fatal hemorrhage, excision of the 
uterus or ligation of the arteries 
would be morally licit, even though 
the fetus would die through the 
cutting off of the blood supply. 
For the object of the operation is 
an organ of, or something belong- 
ing to the mother, the condition of 
which, here and now, threatens her 
life ; it is only then, indirectly, and 
in consequence of the means em- 
ployed to save that life, that the 
death of the fetus is permis- 
sible. 



40 ACUTE CASES IN MORAL MEDICINE 

of iB ovum. ( 5 ) ^ n treating diseases of the ovum 
the moral aspect varies with the 
certainty of diagnosis and the na- 
ture of the disease. The ordinary 
conditions requiring ethical con- 
sideration are the mole, hydram- 
nios and clear ovum. 

MolQ - (a) Mole. It must be remem- 

bered that where there is any rea- 
sonable ground for doubt, the pre- 
sumption stands in favor of a 
normal conception ; hence when the 
presence of a mole is suspected, the 
diagnosis must be certain enough 
to offset the assumption of a prob- 
able pregnancy before any opera- 
tive procedure may be begun. 
However, hemorrhage is charac- 
teristic of the mole in any of its 
species. If, then, the bleeding is 
dangerously profuse, packing to 
check it is permissible; the re- 
moval of the pack may be followed 
by curettement or hysterectomy, ac- 



TEMPORAL BIGHTS 41 

cording to the demands of the case. 
But if the diagnosis of mole is cer- 
tain and it is threatening the life 
of the woman in some other way 
than through hemorrhage, it may 
be removed, even though it involve 
a fetus. However, such cases are 
practically unknown after the first 
three months of pregnancy. If the 
mole involves a fetus it should be 
opened upon removal, so that if 
possible, Baptism may be admin- 
istered. 

(b) Hydr amnios — excessive li- Hydramnios. 
quor amnii. There may be no arti- 
ficial interference with the course 

of pregnancy unless the child has 
reached the stage of viability ; the 
liquor amnii belongs to the ovum 
and it is necessary for the life of 
the fetus. 

(c) Clear ovum — one in which ciear ovum, 
the embryo has been dissolved in 

the water of the ovum. The con- 



. 42 ACUTE CASES IN MORAL MEDICINE 

dition is difficult to diagnose; in 
case of doubt, the presumption 
always stands for life, the fact of 
death must be established upon 
reasonable grounds. Hence, to 
render operative interference licit, 
moral certainty as to diagnosis is 
required. 

Tumors of C. Finally, the cases which present 
the greatest difficulty from the stand- 
point of both medical and moral science 
are tumors of the womb. 

Depending upon their location, uterine 
tumors may be within, between the walls 
of, or on the womb; hence they are 
termed submucous, intramural and sub- 
serous, respectively ; depending upon 
their nature, they may be benign, as 
fibromyomata, or malignant, as carcino- 
mata. 

nbro- (a) Fibromyomata. It may be stated 

myom&ta. 

that, as a rule, operative inter- 
ference should be deferred as long 



TEMPORAL RIGHTS 43 

as possible, for, according to the 
highest authorities, the majority 
of women who have fibromyomata 
go to delivery without trouble ; in 
that case the procedure will be 
such as the skillful obstetrician 
deems best. 

If, however, profuse hemor- 
rhage threatens the mother's life 
or if the tumor has become septic, 
its removal is morally licit, — and, 
if you except the submucous, the 
removal does not necessarily 
cause abortion; statistics point 
the other way. 

Further, were profuse hemor- 
rhage to follow the excision of the 
tumor and were the only means 
of saving the mother amputation 
of the pregnant uterus, that too 
would be licit, as the conditions 
requisite for the twofold effect 
are verified there. 

Finally, if a submucous tumor 



Car- 

cinomata. 



44 ACUTE CASES IN MORAL MEDICINE 

involving the fetus has become 
gangrenous and its removal is 
necessary to save the life of the 
mother, again on the double-effect 
principle, its enucleation is licit, 
even though the removal will 
hasten the death of the fetus. 
(See Special Cases, 3.) 

(b) Carcinomata. A strikingly clear 
exposition of the ethical aspect of 
operative procedure when cancer 
complicates pregnancy is to be 
found in Dr. O'Malley's work: 
1 ' The Ethics of Medical Homicide 
and Mutilation. ? ' On page 150 
the doctor writes: "Cancers of 
the cervix are always malignant 
and cause death if they are not 
removed before they have gone 
on to metastasis." The case, as 
Dr. O'Malley explains, presents 
many aspects according as the 
mother is operable or inoperable 



TEMPORAL RIGHTS 45 

— has one chance in four or none 
at all — and the child viable or in- 
viable. Hence there are the fol- 
lowing possibilities: 

(a) If the mother is operable 
and the child viable, the 
proper procedure is ce- 
sarean section and hyster- 
ectomy. Every good and 
reasonable mother should 
submit to it, if for no other 
reason than to save the 
child. In fact the only 
reason why moralists do 
not make operation a duty 
in this case, is that it is 
considered a more than or- 
dinary means to preserve 
life. In the preservation 
of life we are strictly 
obliged to employ only or- 
dinary means. (Confer pp. 
97-100.) 



46 ACUTE CASES IN MORAL MEDICINE 

(b) If the mother is inoperable 
and the child viable, the 
mother may submit to ce- 
sarean section to save the 
child, but she has no strict 
duty to do so ; nor may the 
operation be performed un- 
less her consent has been 
obtained after she has been 
made fully aware of the 
circumstances. 

(c) If the mother is inoperable 
and the child inviable, there 
is nothing to do but to wait 
in hope that the child may 
reach viability. 

(d) If the mother is operable 
and the child inviable, in 
accord with strict moral 
probability, operative pro- 
cedure is licit. Under the 
most favorable circum- 
stances the child has but 



TEMPORAL RIGHTS 47 

one chance in two of going 
on to viability; if opera- 
tion is deferred, its chances 
diminish with those of the 
mother ; on the other hand, 
the chances of the mother 
diminish rapidly, even a 
few days may suffice to 
render her inoperable. 
Hence the conclusion of Dr. 
'Malley : ' ' The one chance 
in four in immediate opera- 
tion gives the mother a 
solid ground for hope, and 
the probability is sufficient, 
in my opinion, to permit 
the operation with a per- 
missive loss of the fetus." 

From the solution just proposed, it 
follows that it is morally licit to treat 
carcinomata with X-rays ; besides, in the 
present advanced stage of methods of 
treatment, it is by no means certain that 



48 ACUTE CASES IN MORAL MEDICINE 

the fetus would be injured ; even though 
it were, the grave condition of the 
mother would render the risk permis- 
sible. 

in 
Surgical Removal of an Ectopic Fetus 

Definition. Ectopic gestation is a ges- 
tation that is out of place, a gestation 
outside its normal site within the womb. 

Species. Ectopic gestation has a 
broader meaning than extra -uterine 
pregnancy. It includes not only gesta- 
tion outside the uterus in the adnexa or 
peritoneal cavity, but also gestation in 
the horn of an abnormal or rudimentary 
uterus as well as gestation in that part 
of the fallopian tube which lies within 
the uterine wall. "As," in the words 
of Professor Williams, "the fertilized 
ovum may be arrested at any point on 
its way from the graafian follicle to the 
uterine cavity, it may undergo develop- 



TEMPOEAL BIGHTS 49 

ment in the ovary or in any portion of 
the tube, giving rise to ovarian or tubal 
pregnancy, respectively. ' ' There is much 
discussion as to whether a primary ab- 
dominal pregnancy is possible, but that 
has no practical bearing upon the ethical 
aspect of the question ; certainly abdom- 
inal pregnancies exist, and, whether pri- 
mary or secondary, they have to be dealt 
with. Hence there are three species of 
ectopic gestation — ovarian, tubal, and 
abdominal; by far the most common of 
these is tubal pregnancy. 

Morality. An ectopic gestation, no 
matter what its species, deserves the 
same consideration as the fruit of a 
normal conception. Its situs is not of 
its own choice, it is entirely undirected 
by its own will, it is an innocent human 
being, hence it has a right to life. But 
as there are various circumstances in a 
normal conception where operative pro- 
cedure may result indirectly in the death 
of the fetus, so, too, there are similar 



50 ACUTE CASES IN MORAL MEDICINE 

cases of ectopic gestation. Those ordi- 
narily met in practice are the following : 

1. Maternal hemorrhage and collapse. 
Surgically, celiotomy and hemostasis are 
urgently indicated, and the procedure is 
perfectly licit morally. 

2. A tumor containing a living fetus. 
If the tumor is endangering the mother's 
life, whether it be from malignancy or 
from other causes, it may be removed, 
even should the fetus contained therein 
be inviable. If it is not endangering the 
mother's life it may not be removed. 
Of course it is evident that, in the 
absence of such neoplastic tissue, the 
ectopic sac itself may not be removed 
on the plea that it is a tumor dangerous 
to the woman's life. 

3. An interior growth of undeter- 
mined nature. The growth may be a 
tumor, a pyosalpinx, or a fetus. Neither 
the ordinary signs nor the history of the 
case afford grounds sufficient for a posi- 
tive diagnosis. While in such a con- 



TEMPORAL RIGHTS 51 

tingency operative procedure would be 
strictly licit, yet, if no immediate crisis 
is feared, the expectant treatment is 
preferable morally; but if the physi- 
cian's practiced eye observes an ap- 
proaching crisis, owing to the insoluble 
doubt, he is permitted to open the ab- 
domen; if the diagnosis is still uncer- 
tain, he may slit the tube and finish the 
operation even though he finds a living 
fetus, for once the tube has been opened 
the arteries must be ligated to prevent 
fatal maternal hemorrhage. But if in 
any particular case, after celiotomy, 
before opening the tube, the diagnosis 
of a fetal presence becomes certain, 
morally, he can proceed no further. That 
tubal abortion or tubal rupture may oc- 
cur in a few hours or a few days is not 
sufficient reason to attack directly and 
remove a fetus which here and now is 
developing in accord with natural laws 
without any serious indication of ma- 
ternal collapse or hemorrhage. 



52 ACUTE CASES IN MORAL MEDICINE 

At this juncture it may be well to add 
that the application of electric current 
or the injection of various poisonous 
substances to destroy the contents of 
the growth of a doubtful nature, would 
be as morally wrong and as absolutely 
unjustifiable as Dr. Williams says they 
would be in an ectopic pregnancy where 
the diagnosis is positive. 

4. A positive diagnosis of tubal preg- 
nancy : 

(a) If the fetus is dead, remove 
it. 

(b) If there is doubt as to life, then 
the solution depends on the 
urgency of the case ; if the case 
is not urgent, wait ; but if there 
are signals of danger, even 
aside from hemorrhage and col- 
lapse (e.g., toxemia), of which 
only the practiced physician 
can judge accurately, then the 
certain right of the mother pre- 



TEMPOBAL RIGHTS 53 

vails over the doubtful right of 
the child, and the surgeon is 
justified in operating. 

(c) If the fetus is viable, remove 
it. 

(d) If the fetus is inviable, the pro- 
cedure depends upon the cir- 
cumstances. If there are no in- 
dications of hemorrhage or col 
lapse, nothing can be done but 
wait. No operation may be per- 
formed which has for its object 
the removal and killing of the 
fetus either as a means or as an 
end. If there are symptoms of 
hemorrhage, the patient must 
be watched closely, everything 
kept in readiness and the mo- 
ment her condition gives evi- 
dence of becoming grave, the 
woman should be opened imme- 
diately, the arteries ligated, and 
the extracted fetus, if not cer- 
tainly dead, baptized. 



54 ACUTE CASES IN MORAL MEDICINE 

Permit me, then, to reiterate with 
added emphasis what I said in the begin- 
ning concerning an ectopic fetus : The 
ectopic fetus has the same right to life 
as the fruit of a normal conception, and, 
in consequence, deserves the same con- 
sideration and demands the same pro- 
tection. 

IV 

Special Cases 

From the foregoing discussion and 
application of principles a few conclu- 
sions of practical moment may be drawn. 
Euthanasia. l. Even though the state of the sick, 
the insane, the criminal, the mother, be 
helpless, it is, nevertheless, murder to 
drug them into eternity. They may be 
irremediably afflicted but they remain in 
full possession of their rights ; their con- 
dition may seem hopeless, yet in similar 
instances time has proven the judgment 
of mere men wrong. Besides, who is 



TEMPORAL RIGHTS 55 

man that he should assume life mastery- 
over an innocent human creature ? The 
advocates of this wholesale slaughter of 
the innocents use the euphemistic term 
euthanasia, an easy death, but in bring- 
ing it about they run contrary to the 
command of God and usurp His right. 
Euthanasia, despite the easy, is less 
honorable than the murder committed by 
the thug; the latter takes a chance on 
being caught and convicted, the easy 
death advocate escapes because a social 
conscience is warped. While it is licit 
to administer morphine with discretion 
in quantity sufficient to ease suffering 
and produce necessary sleep, yet to rob 
the patient purposely of the use of his 
faculties in his last hours is unscrupu- 
lous and criminal. 

2. Twilight Sleep is a method in- |£^ gllt 
tended to effect painless childbirth 
through the use of scopolamine and 
morphine. Although introduced as late 
as 1902, it is even now being discon- 



56 ACUTE CASES IN MORAL MEDICINE 

tinued by the authorities in the medical 
profession. Green of Harvard, Williams 
of Johns Hopkins, Hirst of Pennsyl- 
vania, DeLee of Northwestern, not to 
mention the eminent practitioners Baer, 
Edgar and Holmes, look askance at its 
general use. It has been given a fair 
trial; the desired results have not been 
obtained. It does not prevent the pains 
of labor, but at most destroys the recol- 
lection of them. According to Dr. Wil- 
liams (Obstetrics — page 347) ordinarily 
the women complain bitterly during the 
pains, and some women contend that 
they have perfect recollection of their 
severity. Besides, it prolongs labor, 
renders more frequent operative de- 
livery, brings forth apneic children, en- 
genders unslakable thirst, induces head- 
ache, vertigo, and delirium, and through 
restlessness increases in the mother the 
risk of self infection. Finally, there is 
ever present the danger of destroying 
the life of the child through asphyxia, 



_ 



TEMPORAL RIGHTS 57 

and the life of the mother through post- 
partum hemorrhage. 

These are the scientific facts on which 
the moral judgment is based. In every 
case there is serious risk of performing 
grave evil to effect slight good. To 
alleviate the pains natural to childbirth 
a host of ills is introduced and fetal and 
maternal life placed in jeopardy. It is 
obvious then that there is no proper pro- 
portion between the good and evil 
effects. Hence while it is entirely pos- 
sible that in the future vast improve- 
ment may be made in regard to its ad- 
ministration, in the present stage of its 
development Twilight Sleep is both 
unscientific and immoral. Some mem- 
bers of the medical profession even 
consider its administration little short 
of malpractice. 

3. There may be no operation on any ™jff t|1fflf 
of the female generative organs, unless 
their condition be so diseased as to de- 
mand it, and then only in so far as is 



58 ACUTE CASES IN MORAL MEDICINE 

necessary to remedy the condition effec- 
tively. This prohibition affects not only 
hysterectomy and ovariotomy (oopho- 
rectomy), but also the burial and the 
closure as well as the removal of the 
tubes (salpingectomy). It applies as 
well to X-ray and radium treatment 
which without operative interference 
may be employed for purposes of ster- 
ilization. That pregnancy may, per- 
haps, aggravate a disease such as 
tuberculosis, is no more reason for 
permitting sterilization than would be 
the desire of some society women to 
escape the primary and legitimate bur- 
den of marriage. Such an operation is 
a grave mutilation without sufficient 
reason, hence it is a violation of the 
moral order, and, therefore, a deordina- 
tion strictly forbidden. The same is 
true of vasectomy. The State has no 
right to authorize it. Further, where 
only one tube or one ovary is diseased, 
it is not lawful to remove the undis- 



TEMPORAL RIGHTS 59 

eased tube or the undiseased ovary to 
guard against possible future infection. 
Such procedure would constitute a grave 
mutilation without sufficient reason. 
The evil would be certain and pres- 
ent, the good but possible and re- 
mote. 

There is, however, a peculiar case con- 
cerned with the female generative or- 
gans in which mutilation is not pro- 
hibited. Sometimes a fibroid so involves 
the uterus that it cannot be removed 
unless the uterus is taken out together 
with it. Xow, even though the only 
danger to the woman is from recurrent 
abortion owing to the presence of the 
tumor in the womb, that is sufficient to 
justify the extirpation of a uterus so 
affected. But when there is no other 
danger to the woman than that resulting 
from the possible abortion, hysterectomy 
would not be licit were the uterus actu- 
ally gravid with fetal life. (See Fibro- 
in} omata, p. 42.) 



60 ACUTE CASES IN MORAL MEDICINE 

operation. 4t " ** * s morally wrong to perform 

an operation, it is also morally wrong to 
assist in it, or even to be present at it. 
There is such a thing as formal coopera- 
tion which makes the one who cooperates 
equally guilty with the perpetrator ; it is 
not a slight offense to stain one's hands 
with innocent blood; it is not a small 
thing to be a party to a procedure which 
runs contrary to the canons of ordinary 
decency and is directly opposed to the 
first principles of the Natural Law\ If, 
however, a nurse does not know and has 
no reason to suspect that an illicit opera- 
tion is to be performed (embryotomy, 
abortion, removal of ectopic fetus in 
absence of maternal shock and hemor- 
rhage, impairing the function of any 
reproductive organs without necessity) 
she is in no wise responsible ; if she has 
well-founded reasons to suspect, her 
only course is a positive and unqualified 
refusal to assist. If dismissal from the 
school, the case, or the service of the 



TEMPORAL RIGHTS 61 

doctor follows such an action, let her 
rejoice in duty done, remembering the 
while that such schools and such doctors 
do not like publicity. It goes without 
saying that the nurse in charge of the 
operating room should be apprised of 
the nature of the operation about to be 
performed. Even, especially where 
moral questions are involved, it may be- 
come her duty to inquire into the neces- 
sity of certain procedures, which many 
have come to consider a matter of surg- 
ical routine. Nor should it be neces- 
sary to mention that following the 
doctor's orders in giving drugs which 
are plainly designed to terminate an 
apparently played-out life would mani- 
festly be cooperation in human slaugh- 
ter. What is said here of a nurse is 
equally true of an assistant doctor 
placed in a similar position. 

While refusal to be party to an il- 
licit operation is absolutely imperative, 
once the crime had been committed, it 



62 ACUTE CASES IX MORAL MEDICINE 

would not be wrong to nurse such a 
patient. 
5*» 5. The doctor and the nurse must be- 

Suicide. 

ware of the unscrupulous and those with- 
out conscience who seek information that 
they may turn it to criminal use. The 
ugliest practices are being indulged in 
nowadays simply for the sake of sexual 
pleasure or in virtue of the claims of 
so-called economic necessity; and worse 
still, in the name of social progress they 
are receiving public attention and almost 
authoritative sanction. These crimes 
are the ruin of the individual and a 
menace to the nation. They attack the 
sanctity of the home and, thereby, shake 
the very pillar of the state. Hence, the 
doctor and the nurse, far from divulging 
should guard as a sacred trust the 
professional knowledge which could be 
turned to wicked uses. Xow as never 
before the world needs strong characters 
firmly rooted in moral principles and 
grimly determined in their courageous 



TEMPORAL RIGHTS 63 

application to stick to the outposts of 
righteousness till society, high and low, 
its dizzy spell over, returns to sane 
thought and action. 

6. The doctor, physician or surgeon, uo£ 8Ulta " 
is the self -professed and legally consti- 
tuted guardian of human life. It is his 
to conserve and not to destroy. The re- 
lated experience of men eminent in the 
medical profession manifests how fre- 
quently a diagnosis has been faulty, and 
clinical discussion shows forth how often 
in properly diagnosed cases the treat- 
ment has been faulty. Hence the neces- 
sity of strong exhortation to prudence in 
both diagnosis and treatment, and where 
there is serious doubt as to diagnosis or 
treatment, the patent necessity of com- 
petent consultation. Consultation is 
necessary occasionally for the old and 
experienced, frequently necessary for 
the young and less experienced. Con- 
sultation should be the constant rule in 
all cases where the doctor is not sure as 



64 ACUTE CASES IN MORAL MEDICINE 

to the proper procedure, and this is espe- 
cially true when disease complicates 
pregnancy and threatens either maternal 
or prenatal life. 

The greater a man is in his profession, 
the more readily will he acknowledge his 
limitations and the more apt will he be 
to seek advice where human life is hang- 
ing in the balance. 



PAET II 

SPIRITUAL RIGHTS 

RELIGION 
CARE OF THE SOUL 

The soul of even the humblest among men is of 
priceless value. Immortal by nature, by grace it 
is fitted for eternal glory. In serious illness when 
the danger of death is even slight, the relatives or 
friends of the patient should be apprized at once, 
that they may interest themselves in his spiritual 
welfare. And without disturbing his religious 
convictions the nurse in all fitness may propose 
motives of sorrow to such a patient and elicit from 
him acts of perfect contrition. 



A. Baptism of Necessity 
I. Establishment of Principles 

1. What is Baptism of Necessity? 

Baptism of Necessity is Baptism 
in which the mere essentials of 
the sacrament are performed, 
the other ceremonies usually 
prescribed by the Church being 
omitted. 

2. When is it administered? 

It is administered whenever 
there is danger that he (child or 
adult) may die before he can be 
brought to the Church for 
Solemn Baptism. 

3. Who is to administer it? 

Anyone having the use of reason 

may baptize validly, provided he 

perform what is required and 
07 



68 ACUTE CASES IN MORAL MEDICINE 

have the intention of doing what 
the Church of Christ intends by 
Baptism. Yet when possible, a 
certain order of preference is to 
be observed. If a priest can be 
called it is his duty to administer 
the sacrament; if one cannot be 
summoned readily, then a cleric 
(deacon, subdeacon, etc.) takes 
precedence over a lay person ; a 
man is preferable to a woman. 
Only when no competent person 
is available should the father or 
mother of the child perform the 
rite. 
4. How is it to be administered? 

It is to be administered by pour- 
ing water on the head (forehead) 
of the one to be baptized, in 
quantity sufficient to flow, and at 
the same time the person pouring 
the water must pronounce dis- 
tinctly the words: "1 baptize 
thee in the name of the Father 



SPIRITUAL RIGHTS 69 

and of the Son and of the Holy 
Ghost." "While it is not neces- 
sary, yet the water may be so 
poured as to make three distinct 
crosses on the forehead; the 
words, however, are to be pro- 
nounced but once. 

Observation 
As regards 

1. The water 

(a) Clear natural water is to be 
used ; it may be water from 
the tap or pump, spring 
water, rain water, sea water, 
water from the river, pond 
or fountain, water from 
mists or dew, condensed 
steam or melted ice, water 
sterilized or boiled. 

(b) The water must touch the 
skin and is to be poured in 
quantity sufficient to flow; 



70 ACUTE CASES IN MORAL MEDICINE 

enough could be held in a 
cupped hand; where bap- 
tism might occasion disturb- 
ance a handkerchief or bit of 
gauze soaked in water could 
be wrung out so that the 
drops would run on the fore- 
head. 

2. The ivords 

A. Absolute baptism 

(a) The proper w T ords are: 
"1 baptize thee in the 
name of the Father and 
of the Son and of the 
Holy Ghost." All must 
be pronounced — it is not 
enough to say: "In the 
name of the Father and 
of the Son and of the 
Holy Ghost"; the words 
"7 baptize thee" are also 
essential; there must be 
no substitution, no appa- 






SPIRITUAL RIGHTS 71 

rent equivalents. The 
word "Amen" should 
not be added at the 
end. 

(b) The words are to be pro- 
nounced by the person 
pouring the water; one 
may not pour the water 
and another say the 
words, nor may anyone 
baptize himself. 

(c) The words are to be pro- 
nounced, not after, not 
before, but while pouring 
the water. 

(d) The words are to be pro- 
nounced distinctly; it is 
not enough to think 
them ; they must be care- 
fully expressed; the 
words can be spoken 
clearly even in a whisper 
and it is not necessary 



72 ACUTE CASES IN MORAL MEDICINE 

that they be perfectly 
audible to bystanders. 

B. Conditional baptism 

Sometimes there may be 
reason to doubt 

(a) As to whether the person 
was previously baptized, 
or 

(b) As to whether the pre- 
vious baptism was valid, 
or 

(c) As to whether the person 
is living, or 

(d) As to whether the object 
under consideration is 
human, then the baptism 
is to be conferred condi- 
tionally. The words ex- 
pressing the condition 
are themselves distinctly 
pronounced and prefixed 
to the proper form ; for 



SPIRITUAL RIGHTS 73 

example, if there were a 
doubt as to whether the 
person were previously 
baptized, the conditional 
form would be : "If thou 
art not baptized, I bap- 
tize thee in the name of 
the Father and of the 
Son and of the Holy 
Ghost." Although the 
words expressing the 
condition vary under dif- 
ferent circumstances, yet 
should the person bap- 
tizing not know how to 
formulate the conditions 
in a particular case, it is 
always safe to use the 
one of capability: "If 
thou art capable, I bap- 
tize thee in the name of 
the Father and of the 
Son and of the Holy 
Ghost." 



74 ACUTE CASES IN MORAL MEDICINE 

Note especially: In baptism of neces- 
sity 

1. There need be no name given. 

2. There need be no sponsors, unless 
one can be procured easily ; yet, if 
possible, there should be at least 
one witness to the fact of baptism. 

3. There must be probable danger of 
death. Should a nurse, however, 
about to leave a case, feel morally 
certain that the child is in such 
condition that it will die soon and 
probably without baptism, she may 
administer the sacrament before 
departure. 

4. The one who baptizes should make 
a precise record of all that has been 
done. The record should contain 
the name, if one has been given, the 
age, the parent's names, the name 
of the one who administered the 
private baptism, and relate how it 
was done. All this information 



SPIRITUAL RIGHTS 75 

should be presented to the priest 
of the parish to which the person, 
thus privately baptized, belongs. 

II. Application of Principles 

At any time occasions may arise which 
demand clear thought and quick action. 
The emergency may regard either an 
adult or an infant. By an adult is meant 
anyone who has attained the use of 
reason; while an infant is one who has 
not attained the use of reason, even 
though he be advanced in years. 

A. An Adult in Danger of Death 

1. // conscious: For the valid recep- 
tion of baptism it is necessary 
that the adult have the intention 
of receiving it, that he ask to be 
baptized or at least assent to be 
baptized when questioned regard- 
ing it. Now: 

(a) If there is time for instruc- 
tion, call a priest. If this is 



76 ACUTE CASES IN MORAL MEDICINE 

not convenient or there is 
danger in prolonged delay, 
let the nurse in charge or 
some person well-informed 
teach him the principle mys- 
teries of religion: 

1. That God exists and is a 
Eewarder of them that 
seek Him. 

2. That in God there are 
three Persons, and that 
the Second Person became 
man and died for our sins. 

3. That it is necessary to 
pray. 

That done, the person should 
be told to be sorry for his sins 
and motives of sorrow pro- 
posed to him, namely: 

1. The Infinite Goodness of 
God. 

2. The sufferings and death 
of Christ on the Cross. 



SPIRITUAL RIGHTS 77 

3. The loathsomeness of sin. 

4. The everlasting reward 
that is lost by mortal sin. 

5. The everlasting punish- 
ment to which mortal sin 
makes us liable. 

Finally, an Act of Contrition 
should be made with him. 
(Confer p. 107.) 
Then if the person has never 
been baptized before, baptize 
him absolutely: "I baptize 
thee in the name of the 
Father and of the Son and 
of the Holy Ghost." 
If there is doubt regarding 
anyjSjormer baptism, baptize 
him conditionally : "If thou 
art not baptized, I baptize 
thee in the name of the 
Father and of the Son and 
of the Holy Ghost." 

(b) If there is no time for in- 



78 ACUTE CASES IN MORAL MEDICINE 

struction, it is sufficient that 
the person believe in God, 
that he assent in a general 
way to whatever God has re- 
vealed. He should then be 
told to be sorry for his sins 
and baptism conferred as in 
the previous case (a). 
2. If unconscious : For the valid re- 
ception of baptism by an adult, 
the habitual intention of receiving 
baptism is necessary. Now, if the 
unconscious person, either during 
his past life or in his present ill- 
ness has manifested in any posi- 
tive way his intention of receiving 
baptism, he should be baptized 
conditionally: "If thou art ca- 
pable, I baptize thee in the name 
of the Father and of the Son and 
of the Holy Ghost." Eelatives 
and friends might know of such 
intention ; diligent inquiry should 
be made of them ; the unconscious 



SPIRITUAL RIGHTS 79 

person should be given the benefit 
of any doubt. If he recovers he 
should be instructed, then if any 
doubt exists regarding the valid- 
ity of the former baptism, he 
should be baptized conditionally: 
"If thou art not baptized, I bap- 
tize thee in the name of the Father 
and of the Son and of the Holy 
Ghost." 

3. If insane: 

(a) If the person has never had 
the use of reason, he is to be 
baptized absolutely; his con- 
dition is the same as that of 
an infant. 

(b) If the person has had the use 
of reason, then: 

(1) If the insanity is perma- 
nent and there is any 
reason for believing' that 
the person while sane 
manifested any desire of 



80 ACUTE CASES IX MORAL MEDICINE 

receiving it, baptism 
should be administered 
conditionally. But if 
there is no reason for 
believing that any such 
desire ever existed, he 
should not be baptized. 
(2) If the insanity is not per- 
manent, — that is, if there 
are lucid moments or 
periods of saneness, — 
then if there is no danger 
of death, nothing is to be 
done until a rational in- 
terval, when he is to be 
treated as an ordinary 
adult. If, however, there 
is danger of death before 
return of reason, the con- 
dition is to be treated as 
under (1), above. 
4. If comatose: 

What has been said of insanity 
applies with equal force to coma 



SPIRITUAL RIGHTS 81 

or to stupor. Nothing is to be 
done unless there is danger of 
death, and nothing even then, un- 
less the person had previously in 
some way manifested a desire of 
receiving baptism. If some prob- 
able manifestation of desire for 
the sacrament is obtained, then 
the person is to be baptized con- 
ditionally: "If thou art capable, 
I baptize thee in the name of the 
Father and of the Son and of the 
Holy Ghost." Upon the recovery 
he is to be instructed and if any 
doubt exists as to the validity of 
the former baptism, he is to be 
baptized conditionally: "If thou 
art not baptized, I baptize thee in 
the name of the Father and of the 
Son and of the Holy Ghost." 

B. An Infant: the case of: 

1. A child bom showing no sign of 
life. The absence of evidenl signs 



82 ACUTE CASES IN MORAL MEDICINE 

of life is not a certain proof of 
death. In an intact fetus the only 
sure sign of death is putrefaction 
or decomposition. Hence if the 
fetus is not mangled to an extent 
that would render the presence of 
life impossible, or if dissolution 
or maceration is not discernible, 
it must be baptized conditionally : 
"If thou art alive, I baptize thee 
in the name of the Father and of 
the Son and of the Holy Ghost." 

2. A child born prematurely — pre- 
mature being taken in the wide 
sense of abortion or miscarriage : 

(a) If what is ejected is recogniz- 
able as a living fetus, no 
matter how small, it is to be 
baptized absolutely: "1 bap- 
tize thee in the name of the 
Father and of the Son and 
of the Holy Ghost." If there 
is any doubt as to life, it is 



SPIRITUAL RIGHTS 83 

to be baptized conditionally: 
"If thou art alive, I baptize 
thee in the name of the Fa- 
ther and of the Son and of the 
Holy Ghost." 

(b) If what is ejected is not rec- 
ognizable as a living fetus, it 
may be a fertilized ovum or 
its membranes, or a patho- 
logical growth, it is then to 
be baptized conditionally: 
"If thou art capable, I bap- 
tize thee in the name of the 
Father and of the Son and of 
the Holy Ghost." 

(c) If the embryo is delivered in 
its membranes: 

1. If it seems well-developed, 
open the_sac carefully, 
drain off the amniotic 
fluid and pour water on 
the fetus, using the form : 
"7/ thou art alive, I bap- 



84 ACUTE CASES IX MORAL MEDICINE 

tize thee in the name of 
the Father and of the Son 
and of the Holy Ghost." 
2. If it is not well-developed, 
then open the sac under 
tepid water so that the 
water floods the sac fully; 
then lift it out and place 
it in the water again three 
times, pronouncing at the 
same time, once only, the 
form: "If thou art capa<- 
ble, I baptize thee in the 
name of the Father and of 
the Son and of the Holy 
Ghost." 
Note. In case of such immature 
births, do not lose valu- 
able time trying to ascer- 
tain definite signs of life. 
If the fetus is not cer- 
tainly dead, give it condi- 
tional baptism at once. 
The same injunction holds 



SPIRITUAL RIGHTS 85 

in regard to immature 
ectopic fetuses. 

A difficult parturition: 

(a) Within the womb. While 
there remains a well- 
grounded hope that the child 
will be born alive, baptism 
within the womb is not to be 
attempted. If there is grave 
reason to believe that the 
child will not be born alive, 
then it is the duty of the 
physician (who best knows 
how to apply the water with- 
out endangering the life of 
the child) to try to reach the 
child through the vagina by 
means of some instrument, 
as an aseptic syringe filled 
with sterilized water. The 
baptism is to be conferred 
conditionally: "If thou art 
capable, I baptize thee in the 



86 ACUTE CASES IN MORAL MEDICINE 

name of the Father and of the 
Son and of the Holy Ghost." 
If the danger of death con- 
tinues, the child upon full 
delivery, or upon presenta- 
tion of the head, is to be bap- 
tized again, conditionally : 
"If thou art not baptized, I 
baptize thee in the name of 
the Father and of the Son 
and of the Holy Ghost." 
Even a non-Catholic mother 
should, if possible, be per- 
suaded to permit intrauterine 
baptism that the child be 
given every chance of spir- 
itual happiness. 
(b) In delivery. This assumes 
that delivery is in progress 
but there is danger that the 
child may die before being 
completely delivered. The 
probable cases of presenta- 
tion are : 



SPIRITUAL RIGHTS 87 

1. The head. It is to be bap- 
tized absolutely as under 
normal circumstances : "I 
baptize thee in the name 
of the Father and of the 
Son and of the Holy 
Ghost." 

2. A prominent or less prom- 
inent part such as shoul- 
ders, back, buttock, chest, 
hand, arm, foot, leg, re- 
spectively. The part pre- 
sented is to be baptized 
conditionally : "If thou 
art capable, I baptize thee 
in the name of the Father 
and of the Son and of the 
Holy Ghost." Then upon 
delivery, provided the 
child still lives and the 
danger has not passed, the 
child is to be baptized 
again conditionally: "If 
thou art not baptized, I 



88 ACUTE CASES IN MORAL MEDICINE 

baptize thee in the name 
of the Father and of the 
Son and of the Holy 
Ghost." 

4. The children of non-Catholic pa- 
rents. The indiscriminate bap- 
tism of children of non-Catholic 
parents is certainly wrong. That 
private baptism be allowed, there 
must be danger of death, and 
where this is present, the children 
are to be baptized even against 
the will of their parents. This 
can be done quietly, without osten- 
tation; if the child survives, he 
should be informed of his duty at 
least at the age of discrimination. 
(Confer Observations 1 (b),ip. 
69.) 

5. Foundlings. If such little cast- 
aways are not in danger of death 
consult a priest. If they are in 
danger of death and no statement 



SPIRITUAL RIGHTS 89 

can be obtained to prove previous 
baptism, then they are to be bap- 
tized conditionally. 

Abnormalities. In case of abnor- 
mal births it is to be noted that if 
baptism is to be conferred, it 
should be administered before the 
placental circulation is cut. The 
deformation may represent the 
appearance of: 

(a) A shapeless mass of flesh, in 
no way distinguishable as a 
human fetus and having no 
lineament of a human body. 
Now such is not to be bap- 
tized. If, however, there is 
any reason to believe that the 
"shapeless mass" # may be a 
human being or a mole con- 
taining a fertilized ovum, 
then baptism is to be con- 
ferred conditionally : "If 
thou art capable, I baptize 



90 ACUTE CASES IN MORAL MEDICINE 

thee in the name of the 
Father and of the Son and of 
the Holy Ghost." Of course, 
in case of the mole it should 
first be opened. 

(b) A human being. If alive, it 
must be baptized absolutely, 
no matter how deformed or 
misshapen it may be : "I bap- 
tize thee in the name of the 
Father and of the Son and of 
the Holy Ghost." If any 
doubt exists as to the pres- 
ence of life, it is to be bap- 
tized conditionally: "If thou 
art alive, I baptize thee in 
the name of the Father and of 
the Son and of the Holy 
Ghost." 

(c) Twin births. Such defor- 
mations may present many 
angles. The terata may be so 
separated that they are quite 
distinguishable or so joined 



SPIRITUAL RIGHTS 91 

that one is almost indistin- 
guishable : 

1. Readily distinguishable: 

(a) One head and one 
chest. Baptize the 
head absolutely: "I 
baptize thee in the 
name of the Father 
and of the Son and of 
the Holy Ghost." 

(b) One head and two 
chests. Baptize the 
head absolutely: "I 
baptize thee in the 
name of the Father 
and of the Son and 
of the Holy Ghost/' 
Then baptize each 
chest conditionally : 
"If thou art not bap- 
tized, I baptize thee 
in the name of the 
Father and of the 



92 ACUTE CASES IN MORAL MEDICINE 

Son and of the Holy 
Ghost." 

(c) Two heads and one 
chest. Baptize one 
head absolutely: "I 
baptize thee in the 
name of the Father 
and of the Son and 
of the Holy Ghost." 
Then baptize the 
other head condition- 
ally : "If thou art not 
baptized, I baptize 
thee in the name of 
the Father and of the 
Son and of the Holy 
Holy Ghost." 

(d) Two heads and two 
chests. Baptize each 
head absolutely: "7 
baptize thee in the 
name of the Father 
and of the Son and 
of the Holy Ghost." 



SPIRITUAL RIGHTS 93 

2. Scarcely distinguishable: 

(a) Two partial heads 
joined and two dis- 
tinct chests. Baptize 
each partial head ab- 
solutely: "I baptize 
thee in the name of 
the Farther and of the 
Son and of the Holy 
Ghost." Then bap- 
tize the other partial 
head conditionally : 
"If thou art not bap- 
tized, I baptize thee 
in the name of the 
Father and of the 
Son and of the Holy 
Ghost." 

(b) If one of the beings is 
fairly developed, and 
the other has no head 
or only a rudimen- 
tary head, the more 
developed one is to be 



94 ACUTE CASES IN MORAL MEDICINE 

baptized absolutely: 
"I baptize thee in the 
name of the Father 
and of the Son and of 
the Holy Ghost/' The 
less developed is to 
be baptized condition- 
ally : "If thou art not 
baptized, I baptize 
thee in the name of 
the Father and of the 
Son and of the Holy 
Ghost." And al- 
though ' i the standard 
of judgment in such 
cases as regards the 
presence of one or 
two souls, is the evi- 
dence of one or more 
distinct conscious- 
nesses " (0 'Malley, 
op. cit., p. 80), yet in 
a matter so important 
as baptism, the safest 



SPIRITUAL RIGHTS 95 

and surest means 
must be employed ; 
conditional baptism 
is to be administered 
lest a soul be de- 
prived of the happi- 
ness of heaven. 

Note. (1) When there is any doubt 
in the aforementioned 
cases as to whether such 
terata are living, the con- 
dition: "If thou art 
alive" must be prefixed 
to the formula. Now, if 
the baptism was condi- 
tional for another reason 
also, the twofold condi- 
tion may be expressed: 
"If thou art alive and 
not baptized, I baptize 
thee in the name of the 
Father and of the Son 
and of the Holy Ghost." 



96 ACUTE CASES IN MORAL MEDICINE 

Or the following brief 
form may be used: "If 
thou art capable I bap- 
tize thee in the name of 
the Father and of the 
Son and of the Holy 
Ghost." 
(2) When in case of such ab- 
normal births danger of 
death is so imminent that 
it is feared there would 
not be time sufficient to 
baptize each separately, 
the water is to be poured 
over them together (on 
the heads or parts corre- 
sponding to the head) 
while the form: "I bap- 
tize you (plural) in the 
name of the Father and 
of the Son and of the 
Holy Ghost" is be- 
ing pronounced but 
once. 



SPIRITUAL RIGHTS 97 



A Woman's 



Unborn Infants and Mothers Death 1 
dead, dying, and sick : If a woman nancy. 
dies in pregnancy, the caesarean 
section is to be performed imme- 
diately and the extracted fetus, if 
certainly alive, is to be baptized 
absolutely, or, if there is doubt 
as to life, conditionally. Should 
the fetus be very small, the pre- 
cautions mentioned in treating of 
premature births are to be ob- 
served. If upon opening the 
womb, the fetus should be found 
to be certainly dead, it should not 
be removed but buried with the 
mother. To absolve the doctor 
and the institution from blame 
and to avert legal entanglements, 
the written permission of the hus- 
band or family to operate should 
be obtained and the woman pro- 
nounced dead in the presence of 
competent witnesses before the 
operation is begun. 



98 ACUTE CASES IN" MORAL MEDICINE 

The obligation of performing the 
cesarean section that the child, if alive, 
may be baptized, is gravely serious, no 
matter how short has been the duration 
of the pregnancy. Primarily, the obli- 
gation rests upon the surgeon, secon- 
darily, upon the nurse in charge or upon 
some other skilled female. Nor should 
the fact that the woman has been dead 
several hours cause hesitation. In- 
stances are on record in which living 
infants have been extracted from the 
womb at a considerable time after the 
mother's death. If it is necessary to 
wait for some one skilled to perform the 
operation, care should be taken to keep 
the woman's abdomen warm by means 
of hot water bottles or electric pads. 
a woman if the woman is already in the throes 
pr^nancy. of death, the acceleration of birth by 
forcibly dilating the cervix is morally 
permissible. "If the woman is slowly 
dying, the fetus is likely to die through 
lack of oxygen." (O'Malley, op. cit., p. 



SPIRITUAL RIGHTS 99 

88) : hence, by turning and delivering 
the child before it is too late, it is saved 
for baptism, and if viable perhaps per- 
manently, while at the same time the life 
of the mother is not determinably short- 
ened. However, neither the spiritual 
nor temporal welfare of the child fur- 
nishes grounds sufficient to justify any 
procedure which would certainly curtail 
the mother's life. In case of doubt there 
is always the expedient of intrauterine 
baptism before, and cesarean section 
after, her death. 

A pregnant woman in grave danger of a woman 
death presents a decidedly practical Dan « er - 
moral difficulty. It may be put in the 
form of a question. Is a woman in a 
critical condition obliged to undergo the 
cesarean section that the child, if alive, 
may be baptized? In answer it is neces- 
sary to draw the line of demarcation 
between the licitness and the obligation 
under the given circumstances. The 
operation would be licit, provided there 



100 ACUTE CASES IX MORAL MEDICINE 

is a likelihood of the fetus being viable 
and that the operation would not be a 
determinable shortening of the mother's 
life. Otherwise the operation would be 
morally wrong. But supposing the 
operation licit, even then the woman 
would not be obliged to submit to it, 
although it were the only way in which 
the infant's spiritual safety could be 
procured. For, while the steady advance 
of surgical technique has rendered this 
operation less bloody and dangerous 
than it was formerly, yet should a 
woman turn from it in abhorrence it 
must be considered an extraordinary 
means and as such cannot be imposed as 
of obligation in a particular case. The 
indications for the operation, the great 
danger of infection, and the maternal 
death rate under the most favorable cir- 
cumstances confirm this view. Hence 
the woman may be urgently persuaded 
but must not be obliged. {Confer 4 'Car- 
cinomata," p. 44.) 



SPIRITUAL RIGHTS 101 

B. The Last Sacraments 
Every Catholic who has attained the 
use of reason and is in danger of death 
is under obligation to receive the con- 
solations of Eeligion afforded by the 
Last Sacraments. Whenever there is 
sickness or accident from which death 
may result, even though the danger is 
not immediate, the pastor of souls should 
be summoned at once. For the Last 
Sacraments are to be given as soon as 
there is real danger of death and while 
the patient is still conscious. Hence the 
doctor and nurse must not wait till he 
has been deprived of the use of his 
senses before acquainting his family, 
relatives or friends with the seriousness 
of his condition. Nay even, since in 
their professional capacity the doctor 
and nurse should ever consult the best 
interests of their patient, in the absence 
of those interested in his welfare, they 
themselves will see to it that the priest 
is called. 



102 ACUTE CASES IX MORAL MEDICINE 

In regard to the administration of the 
sacraments two perplexing situations 
may arise; one has reference to a con- 
tingency following the reception of Holy 
Communion, the other to a case of sud- 
den and unexpected death. 

Holy Communion. It may be stated 
as a rule that even though the patient 
be conscious and able to swallow, yet 
Communion should not be administered 
if his stomach is in an unsettled condi- 
tion. Still, despite the utmost pre- 
caution, it may happen that, after re- 
ceiving, some unforeseen cause induces 
vomiting. In such a contingency the 
reverence due the Blessed Sacrament 
must be safeguarded. 

If vomiting occurs within twenty 
minutes after the reception of the 
Sacrament the entire ejection should be 
placed in a clean vessel and the priest 
notified. 

If a priest cannot be had immediately, 
then the method of procedure depends 



SPIRITUAL RIGHTS 103 

upon whether the Sacred Species is dis- 
cernible or not. If the Host is readily 
discernible It should be separated care- 
fully (by means of a spoon) from the 
other matter ejected and placed in a 
clean vessel. Then It may be taken to 
the priest by a trustworthy person or 
preserved in a safe place awaiting his 
coming. If, however, It is not discern- 
ible, as is usually the case, then the whole 
matter ejected should be absorbed with 
cotton or gauze, burned, and the ashes 
put into the sacrarium. In case the 
accident happens at a private home 
or a hospital with no chapel attached, 
the ashes may be buried in a decent 
place where they will not be dis- 
turbed. 

Of course, these directions are not 
limited to Holy Viaticum but have refer- 
ence to any case in which vomiting oc- 
curs within twenty minutes after receiv- 
ing Holy Communion. 

The second difficulty in the adminis- 



104 ACUTE CASES IN MORAL MEDICINE 

tration of the Sacraments from which 
complications may arise has reference 
to the moment of death. 

Moment of Death. Strange as it may 
seem, it is not always easy to say, in each 
particular case, just when death occurs. 
The rigor of death and the general dis- 
solution of the organism are the only 
certain signs of death known at present. 
Not even an accumulation of the ordi- 
nary signs furnishes sufficient proof that 
life has passed out. Neither any nor all 
are absolutely certain. So many per- 
sons have been revived after what is 
generally termed death, that experts 
admit that, in any case of death, the 
exact moment at which the soul leaves 
the body is unknown. The important 
fact is that life lingers for varying 
periods after apparent death ; how long 
is undetermined, but — 

1. In the case of one in the bloom of 
health snatched away by accident 



SPIRITUAL RIGHTS 105 

or sudden sickness, there is latent 
life possibly for hours; some au- 
thorities claim that there is life till 
the signs of putrefaction become 
apparent. Hence in such cases, no 
matter how long since apparent 
death, the priest should be sum- 
moned that the person may receive 
the benefit of the doubt in the 
conditional administration of the 
sacraments. 

In case of one who has succumbed 
to an ordinary sickness, distinction 
must be made between a wasting, 
protracted disease and one which 
terminates life in a short time and 
rather suddenly. In the former 
latent life may linger for from a 
quarter to a half hour after ap- 
parent death; in the latter, for 
from one hour to possibly three 
hours. While in such contingencies 
the only reason why sick persons 
should have been deprived of spir- 



106 ACUTE CASES IN MORAL MEDICINE 

itual ministrations would be the 
criminal negligence of those in 
charge, yet in the event of their 
being guilty of such grave dere- 
liction, the priest should be 
notified at once and briefly ac- 
quainted with the attendant cir- 
cumstances. 

Here it may be noted that in the case 
of dying people, science has demon- 
strated that the sense of hearing is 
invariably the last to function. Fre- 
quently it remains remarkably acute 
even though there is no other manifest 
evidence of life. Hence, in all cases 
where death is not certain, it is proper 
that appropriate prayers be recited in 
a calm, audible voice ; and it is especially 
fitting that ejaculations, words of resig- 
nation and acts of contrition be spoken 
into the ear of the dying person. The 
following act of contrition was approved 
January 13, 1921 : 



SPIRITUAL BIGHTS 107 

my God! I am heartily sorry for 
having offended Thee, because Thou art 
so very good; and I firmly purpose by 
the help of Thy grace not to offend Thee 
again. (300 days indulgence.) 

C. Christian Burial 

All baptized adults, except those ex- 
plicitly excluded therefrom, are to re- 
ceive ecclesiastical burial. Catechumens 
— those under instruction in the Catholic 
Faith — who, with no fault of their own, 
die without receiving Baptism, are to be 
considered as baptized. Even the am- 
putated members of Catholics, except 
serious difficulties intervene, should be 
buried in consecrated ground or at least 
in a place on the hospital grounds set 
apart and blessed for that purpose. 
And, too, while the disposal of the blood 
taken from our Christian dead in the 
process of embalming has not been made 
the object of specific legislation, yet 
ordinary reverence demands that it be 



108 ACUTE CASES IN MORAL MEDICINE 

not disposed of in an unbecoming man- 
ner. (Ecclesiastical Review, January, 
1921.) 

Baptized infants are to be buried in 
consecrated ground according to the 
laws of the Church. Unbaptized infants 
as human beings have a right to a re- 
spectable interment. Xo matter how 
immature, they should be buried de- 
cently and should never be disposed of 
in any other way. 

In case of the death of both mother 
and child, the child, be it unborn or still- 
born, is to be buried with the mother 
even though unbaptized. 

Let it be noted here that there exists 
no ecclesiastical prohibition of autopsies 
and post-mortem examinations. Of 
course the permission of the relatives 
or friends of the deceased should be 
obtained and the requirements of the 
civil law fulfilled before any dissection 
is begun. 



spiritual rights 109 

General Conclusion 

The substance of the foregoing pages 
refers not only to the physical order, but 
to the social and moral order as well. 
Generally those who consider only the 
physical aspect are extremely prone 
to reach sentimental conclusions, but, 
where right is directly concerned, senti- 
ment must be set aside. 

Not to mention the positive expression 
of the Divine Will, there is a Natural 
Law which may not be disregarded with- 
out peril of conscience. No matter how 
wholesome the intention, it is never al- 
lowed to do evil that good may result. 

Given the conditions explained in 
treating Baptism of Necessity, it is 
readily seen that it causes no grave in- 
convenience, that it entails no loss of 
dignity, that it does not lower self- 
respect. The one who believes in God 
need never be ashamed to manifest that 
belief. Deference to the belief of others 



110 ACUTE CASES IX MORAL MEDICINE 

and the promptings of mere natural 
charity should be sufficient for those who 
do not believe. It is therefore incon- 
ceivable that anyone through a motive 
of hatred, human respect or indifference 
would refuse to perform this rite when 
necessity demands it. 

No matter what their personal per- 
suasion, doctors and nurses in all justice 
should respect the religious belief of 
their patients. And while to the fulness 
of their power they try to further the 
temporal happiness of those entrusted 
to their charge, they should not be un- 
mindful of aught tending to insure their 
eternal glory. Impoverishing not them- 
selves, they may make others rich indeed. 



APPENDIX I 

Decrees of the Holy Office 

The Holy Office is the Roman Congregation 
which deals with faith and morals. It consists of 
a college of Cardinals under the presidency of the 
Pope. They are assisted by numerous consultors 
of different nationalities. They are not endowed 
with the prerogative of infallibility, hence their 
decrees are provisional and not definitive. Need- 
less to say these decrees do not formulate a new 
morality; they simply apply the eternal principles 
of morals to specific cases. 

The subjoined list contains the latest pronounce- 
ments of the Holy Office on the topics treated in 
the foregoing pages. The date is given first, that 
the growth in the legislative utterances may be 
grasped at a glance: 

May 28, 1884. "Craniotomy" condemned. 

August 19, 1889. "Every surgical operation di- 
rectly destructive of the fetus 
or the pregnant mother" con- 
demned. 

July 24, 1895. "Abortion" condemned. 

May 4, 1898. 1. Premature labor in itself is 

not illicit, provided it is done 
for Sufficienl reason, and at 
111 



112 APPENDIX 

the time and by such methods 
as will under ordinary cir- 
cumstances preserve the life 
of the mother and the fetus 

2. Cccsarean delivery may be 
performed at the proper 
time, if the maternal pelvis 
is so narrow that premature 
delivery is impossible. Abor- 
tion, however, is illicit in this 
circumstance according to the 
decree of July 24, 1895. 

3. Laparotomy for the extrac- 
tion of an ectopic fetus is 
lawful, provided the lives of 
both mother and fetus are 
carefully safeguarded. 

March 5, 1902. 1. The extraction of an ectopic 
fetus before the age of via- 
bility is unlawful. 

2. No premature delivery is licit 
unless effected at the time 
and by the methods which, 
under ordinary 7 circumstances, 
will preserve the lives of 
mother and fetus. 



APPENDIX II 

Suggestions 

These suggestions although in no wise entailing 
an emergency, yet contain information of practical 
value to a nurse: 

1. When the sacraments are to be administered 
a tidy room and clean bed linen are the simple 
demands of ordinary respect. The patient, 
too, should have been bathed, combed and 
fittingly attired. Under his chin should be 
placed a clean linen cloth to serve as a Com- 
munion cloth. At the bedside there should be 
a table, with a clean linen cover, on which are 
placed 

(1) A crucifix between two blessed candles 
lighted, 

(2) A glass with water, and a spoon, 

(3) Holy Water and a sprinkler; a sprig 
will serve. 

This is sufficient preparation for the admin- 
istration of Holy Communion. If Extreme 
Unction is given on the same occasion, besides 
the articles just mentioned, there should be 
placed on the table: 

(4) A plate with six small balls of cotton, 

(5) Two little squares of bread. 

113 



114 APPENDIX 

The nurse may kneel during the administra- 
tion of Holy Communion, but should assist 
the priest at the anointing. 

2. The nurse should be conversant with the ordi- 
nary prayers, so that in case of necessity she 
may recite them to the patient. For this pur- 
pose a thorough acquaintance with a good 
prayer book is strongly recommended. There 
are a number of very good ones, such as 
Manual of Prayers, My Prayer Book, With 
God, Blessed Sacrament Book, Treasury of 
the Sanctuary, Rejoice in the Lord, St. Vin- 
cent's Manual, Welcome. 

3. A nurse is called upon frequently to read to 
a patient. Although it is not at all neces- 
sary that she be a theologian, a historian or 
a scientist, yet by a few well-directed ques- 
tions she may readily obtain information as 
to the classics in various fields, the safest 
periodicals of current thought, and the best 
works in modern fiction. Time is too valu- 
able to waste, ideals too precious to destroy. 
Only the best is good enough. 

The following spiritual works are easily 
procured and may be perused with benefit 
and pleasure: 

"Abandonment to Divine Providence," 

Pere Caassade, S. J. 
"Comfort and Consolations for the Sick," 

Rev. Andrew Wyo. 
"Consoler," Rev. Fr. Lambilette. 



APPENDIX 115 

"Consolations of the Sick," Rev. Joseph 

Egger, S. J. 
"Counsels to the Sick," Kathleen 

O'Meara. 
"Devotions and Prayers for the Sick 

Room," Rev. Joseph A. Krebs. 
"Following of Christ," Thomas a Kempis. 
"God and Human Suffering," Rev. Joseph 

Egger, S. J. 
"God and Myself," Rev. Martin Scott, 

S.J. 
"How to Comfort the Sick," Rev. Joseph 

A. Krebs. 
"Hospital Society Addresses," Rev. H. S. 

Bowden. 
"Night Thoughts for the Sick and Deso- 
late," Rev. R. Eaton. 
"Our Daily Bread," Rev. Walter Dwight, 

S.J. 
"Spiritual Pastels," J. S. E. 

A. M. D. G. 



GLOSSARY 

Abdomen. That portion of the body which lies 
between the thorax and the pelvis. 

Abortion. The expulsion of the fetus before it is 
viable. 

Alienable. Capable of being transferred or with- 
drawn. 

Amnion. The innermost fetal membrane forming 
the bag of waters, within which the fetus de- 
velops. 

Anemia. Deficiency of blood either in quantity or 
quality. 

Anesthesia. Loss of feeling or sensation. 

Antipyretic. A remedy for fever. 

Antisepsis. The exclusion of the germs that cause 
infection. 

Apneic. Breathless, privation or suspension of 
respiration. 

Arch. See Pelvis. 

Asepsis. Freedom from infection. 

Atrophy. A wasting in the size of a part. 

Cesarean Section. Delivery by incision through 
abdominal and uterine walls. 

Carcinoma. Cancer, a malignant tumor. 

Celiotomy. Surgical incision into abdominal cav- 
ity. 

Cephalotomy. The culling of the fetal head to 
facilitate delivery. 

117 






118 GLOSSARY 

Cephalotripsy. The crushing of the fetal head to 
facilitate delivery. 

Cervix. The neck, or any neck-like part, — uteri, 
the lower end of the womb. 

Cholecystitis. Inflammation of the gall-bladder. 

Chorea. St. Vitus' dance, a convulsive nervous 
disease. 

Chorion. The more external of the two fetal mem- 
branes, the one which immediately encloses the 
amnion. 

Coma. Insensibility; profound stupor. 

Comatose. In a state of coma. 

Conception. The fecundation of the ovum. 

Craniotomy. The cutting in pieces of the fetal 
head to facilitate delivery. 

Curette. A scraper for removing growths from 
the walls of cavities. 

Curettement. A treatment by the curette. 

Cyanosis. Blueness of the skin from deficient 
oxygenation of the blood. 

Cyst. A sac. 

Cystitis. Inflammation of the bladder. 

Diabetes. A disease marked by habitually exces- 
sive urine. 

Diagnosis. The art of distinguishing one disease 
from another. 

Dilatation. The condition of being stretched be- 
yond the normal. 

Displacement. Removal from the normal position. 

Duty. Moral obligation, something urged or for- 
bidden by law and order. 

Eclampsia. A sudden attack of convulsions; more 
correctly a toxemic condition characterized by 
hepatic lesions. 



GLOSSARY 119 

Ectopic. Out of normal place. 

Embryo. The fetus in its early stages of develop- 
ment. 

Embryotomy. The cutting up of a fetus to facili- 
tate delivery. 

Embryulcia. Destructive instrumental removal of 
a fetus from the uterus. 

Emmenagogue. Any agent stimulating menstrua- 
tion. 

Ethicist. One skilled in the science of Ethics. 

Ethics. The science of morality. 

Eugenics. The science dealing with the improve- 
ment of inborn qualities. 

Evisceration. Disembowelment. 

Excision. The act of cutting away or out. 

Fetus. The child in the womb after the third 
month. 

Fibroid. Resembling a fibrous structure. 

Fibromyoma. A tumor containing fibrous and 
muscular tissue. 

Follicle. One of the small sacs in which eggs are 
enclosed in the ovary. 

Gangrene. The mortification of a part. 

Graafian. Named after Rhinehart de Graaf, a 
Dutch physician of the seventeenth century, — 
graafian follicle. 

Habitual. Pertaining to a habit, e.g., an intention 
once formed and not retracted. 

Hemorrhage. Bleeding. 

Hemostasis. The checking of a flow of blood. 

Hepatic. Pertaining to the liver. 

Hernia. Rupture. 

// yperemesis. Excessive vomiting; — gravidarum 
of the pregnant. 



120 GLOSSARY 

Hysterectomy. The excision of the uterus. 

Immutability. The power of ascribing an act or 
omission to another. 

Inalienable. Not capable of being transferred. 

Incarceration. The unnatural retention of a part. 

Inoperable. Not suitable to be operated upon. 

Inviable. Incapable of life outside the womb. 

Laparotomy. Surgical incision into the abdominal 
cavity. 

Lesion. Hurt, wound, local degeneration. 

Ligate. To tie or bind. 

Liquor amnii. The waters enclosed by the amnion. 

Membrane. A thin layer of tissue covering a sur- 
face or dividing a space. 

Menopause. The period when menstruation nor- 
mally ceases. 

Metastasis. The development of a disease in other 
parts of the body from that in which it was first 
localized. 

Miscarriage. Birth of the fetus before viability. 

Mole. A fleshy mass formed in the uterus by 
degeneration of the ovum. 

Morality. The quality of human actions which 
determines their goodness or badness. 

Mutilation. Deprivation of an integral part of 
the human body; an act whereby a member of 
the body is rendered unfit for normal action. 

Myoma. A tumor made up of muscular elements. 

Narcotic. Producing sleep or stupor. 

Necrosis. The death of a part of the body, morti- 
fication, gangrene; usually applied to bones. 

Necrotic. Affected with necrosis. 

Neoplasm. Any new and abnormal formation. 

Neoplastic. Pertaining to neoplasm. 



GLOSSARY 121 

Nephritis. Inflammation of the kidneys. 

Obstetrics. The art of managing childbirth cases. 

Obstetrician. One who practices obstetrics. 

Operable. Capable of being operated with hope 
of improvement. 

Ovariotomy. Surgical removal of an ovary; more 
correctly oophorectomy. 

Ovary. The female sexual gland in which the ova 
are formed. 

Oviduct. Tube for passage of eggs from the ovary 
— fallopian tube. 

Ovum. The female reproductive cell. 

Oxytocic. Accelerating delivery. 

Parturition. The process of giving birth to a child. 

Pathology. The science of dealing with disease. 

Pelvis. Basin-like bony structure forming the 
support of the viscera in human beings. 

Placenta. The round, flat organ adhering to the 
inner wall of the uterus which establishes com- 
munication between the mother and child by 
means of the umbilical cord. 

Postulate. A statement assumed without proof; 
the truths of kindred sciences granted without 
demonstration. 

Prognosis. A forecast as to the probable result 
of a disease. 

Pyelitis. Inflammation of a section of the kidney. 

Pyosalpinx. Development of pus in the connect- 
ing tube between an ovary and the uterus. 

Responsibility. The state of being accountable or 
liable. 

Sarcoma. A tumor made up of substance like the 
embryonic connective tissue. 

Section. An act of cutting. See C cesarean. 



122 GLOSSARY 

Sepsis. Poisoning by the products of a putre- 
factive process. 

Septic. Condition produced by sepsis. 

Specific. A remedy specially indicated for any 
particular disease. 

Spermatozoon. The motile generative element of 
the semen which serves to impregnate the ovum. 

Sphenotripsy. Crushing the fetal head with an 
instrument applied at the base of the skull. 

Terata. Plural of teras, a monster, a congenitally 
malformed fetus. 

Therapeutic. Curative, pertaining to the art of 
curing. 

Thorax. The part of the human body between the 
neck and the abdomen. 

Toxemia. Blood poisoning induced from without 
or developed from within. 

Toxic. Poisonous. 

Tumor. A morbid enlargement, a mass of new 
tissue with no physiological use, growing inde- 
pendently of surrounding structures. 

Umbilicus. Navel. 

Umbilical Cord. The cord attached to the navel 
of the fetus which connects the fetus with the 
placenta and carries its blood supply. 

Uterus. The womb. 

Vasectomy. The cutting away of all or part of 
the vas deferens, i. e., the tube which carries 
the sperm of man. 

Vasotomy. Incision of the vas deferens. 

Viable. Capable of living outside the uterus. 



BIBLIOGRAPHY 
Part I 

"Codex Juris Canonici." 

"Decreta Congregationis Sancti Officii." 

Antonelli, "Medicina Pastoralis." 

Cathrein, "Philosophia Moralis." 

Coppens, "Moral Principles and Medical Practice." 

Cronin, "Science of Ethics." 

De Lee, "Obstetrics for Nurses." 

Dorland, "Medical Dictionary." 

Genicot, "Theologiae Moralis Institutiones." 

Gould, "Medical Dictionary." 

Howell, "Physiology." 

Klarmann, "The Crux of Pastoral Medicine." 

Lehmkuhl, "Theologia Moralis." 

Meroier-Arendt, "Ethics." 

Noldin, "Summa Theologiae Moralis." 

O'Malley, "The Ethics of Medical Homicide and 

Mutilation." 
O'Malley-Walsh, "Essays in Pastoral Medicine." 
Ross, "Christian Ethics." 
Spalding, "Talks to Nurses." 
Williams, "Obstetrics." 

Part II 

"Codex Juris Canonici." 

"Decreta Congregationis Sacrorum Rituum." 

"Rituale Romanum." 

123 



124 BIBLIOGRAPHY 

Arregui, "Summarium Theologiae Moralis." 
Ferreres, "Compendium Theologiae Moralis." 
Frieburg Instruction, "Baptism of Necessity." 
Ojetti, "Synopsis Rerum Moralium." 
O'Kane, "The Rubrics." 
Sanford, "Pastoral Medicine." 

(Besides those mentioned under Part I.) 



INDEX 



A 

PAGE 

Abortion 21 

accidental 23 

artificial 23, 25 

condemnation of 10, 25 

co-operation of nurses in 60 

criminal 23 

direct, defined 24 

nature and morality of 25 

Holy Office on Ill 

indirect 28 

conditions governing licit 31 

induced 23, 25 

therapeutic, defined 23 

condemned 25 

threatened 36 

hemorrhage in 36 

and contracted pelvis 27 

and infectious diseases 26 

and toxemias of pregnancy 26 

and curettage 37 

when pregnancy aggravates disease x?6 

view of medical science 23 

view of moral science 93 

Actions 

analysis of 15, 16, 17 

morality of 17, 18, 19 

moral determinants of 19 

125 



126 INDEX 

Actions — contiTvued page 

vitiated by bad intention 13 

with double effect 15 

Anemia 

pernicious, in pregnancy 27 

Anesthesia 

in pregnancy 27 

Appendectomy 

in pregnancy 35 

A UTOPS Y 

permission of relatives for 108 

B 
Baptism 

administration of 68 

conditional 72 

in delivery 85 

in emergency 75 

intrauterine 85 

of abnormalities 89 

of adults 75 

comatose 80 

insane 79 

unconscious 78 

of children of non-Catholics 88 

of ectopic fetus 85 

of embryo 83 

undeveloped 82 

well-developed 83 

of fetus 53, 81 

of foundlings 88 

of necessity, denned 67 

of premature child 82 

of probable fetus 83 

of seemingly still-born child 81 

valid minister of 68 

water of 69 

words of 70 

Birth 

acceleration of 

when permissible 22, 98 



INDEX 127 

Blood page 

disposition of, after embalming 107 

Books 

list of spiritual 114 

Burial 

of adults, baptized 107 

of amputated members 107 

of Catechumens 107 

of child with mother 108 

of infants 108 

baptized 108 

unbaptized 108 



C 

Carcinomata 

in pregnancy 34, 44 

X-ray treatment of 47 

Cephalotomy 20 

Cephalotripsy 20 

Celiotomy 

and ectopic gestation 50 

Caesarean Section 

after death in pregnancy 97 

and viable child 27 

an obligation of performance by doctor or 

nurse 98 

Holy Office on 112 

liberty of patient regarding 99 

permission of patient's relatives for 97 

placenta praevia, in 37 

Cholecystitis 

in pregnancy 35 

Chorea 

and abortion 26 

Communion, Holy 103 

physical condition for 102 

preparation for 113 

vomiting after 102 

Conception 

moment of 10 



128 INDEX 

Consultation page 

necessity of, for doctor 63 

Contrition 

act of 107 

motives for 76 

Craniotomy 

Holy Office on Ill 

CuRETTEMENT 

in pregnancy 27 

in case of mole 40 

in threatened abortion 37 



D 

Death 

of woman in pregnancy 94 

moment of 104 

sign of, in intact fetus 81 

signs of, general 104 

Delivery 

baptism in 86 

in separation of placenta 38 

premature 27 

Holy Office on Ill 

requisites for premature 22 

Diagnosis 

uncertainty of proper 63 

principles of moral 12 

Dilatation 

of os uteri 27 

Diseases 

infectious, in pregnancy 26 

of the ovum 40 

Doctor 

and consultation 63 

duty toward patient 109 

responsibility of 63 

when woman dies in pregnancy 97 

Drugs 

and duty of nurse 61 

oxytocic 27 



INDEX 129 

Duty page 

of mother in pregnancy 27 

of nurse 

as custodian of professional knowledge 62 

in illicit operations 57 

in immature births 84 

toward patients 109 

of surgeon 

to hold consultation 63 

toward unborn child 63, 97 



E 

Eclampsia 26 

Ectopic Gestation 

and Baptism 51 

and normal conception 54 

and operative procedure 49 

denned 48 

Holy Office on 112 

immoral treatment in 52 

of doubtful diagnosis in 50 

species of 48 

Embryotomy 

and co-operation of nurse 57 

and medical science 9 

morality of 20 

Murphy, on 20 

species of 20 

Embryulcia 20 

Emergency 

demanding Baptism 75 

Emmenagogue 

in pregnancy 27 

Euthanasia 

immorality of 54 

meaning of 55 

Evisceration 20 

Extreme Unction 

preparation for 113 



130 INDEX 



F 

Fetal Life page 

and direct abortion 25 

and indirect abortion 28 

and separation of placenta 37 

Holy Office on Ill 

Fetus 

and carcinomata 44 

and ruptured uterus 38 

Baptism of 53, 81 

in ectopic gestation 50 

in mole 40 

FlBROMYOMATA 

and operative interference 42 



H 

Hemostasis 

in ectopic gestation 50 

Hernia 

strangulated, in pregnancy 35 

Holy Office 

Decrees of Ill 

denned Ill 

Hydramnios 

cf. Liquor Amnii 

and ovum 41 

Hysterectomy 

and illicit operation 57 

in case of mole 40 

of tumor 42 



Incarceration 

and surgical treatment 36 

Influenza 

and pregnancy 26 



INDEX 131 

IN VI ABILITY PAGE 

and abortion 21 

of fetus 38 



Laparotomy 38 

Law 

Eternal 4 

natural 5 

Life 

and State rights 7 

beginning of 10 

fetal 11 

fetal rights to 54 

fetal, termination of 20 

inalienability of 7 

inviolability of 9 

of unborn child 9 

right to, qualities of 9, 11 



M 

Malaria 

and abortion 26 

quinine in 34 

Mole 

involving fetus 41 

removal of 40 

Morality 

basic principles of 5 

norm of 5 

of embryotomy 20 

of abortion 25 

of removal of ectopic 49 

Morphine 

administration of 55 

Mother 

duties in pregnancy 87 

rights in pregnancy 28, 99 



132 INDEX 

N 

PAGE 

Nephritis 26 

Nurse 

and Baptism 74 

and illicit operations 57 

and patient 109 

and professional knowledge 62 

suggestions for , . . . . 113 

O 

Obstruction 

intestinal, in pregnancy 35 

O'Malley 

on cancer in pregnancy 44 

Oophorectomy 
cf. Ovariotomy 

and illicit operations 60 

Operations 

co-operation of nurses in illicit 60 

Holy Office on 112 

illicit 60 

in disease of ovum 40 

in ectopic gestations 49 

in normal pregnancy 34 

in tubal pregnancy 50 

in uterine tumors 42 

on reproductive organs 57 

Ovum 

clear 41 

disease of 40 

P 

Pelvis 

contracted 27 

malformation of 27 

Physician 

obligations — cf. duties 

relation to abortions 34 



INDEX 133 

Placenta page 

placenta praevia 37 

and premature labor 37 

Caesarean section 37 

Pneumonia 

and abortion 26 

Post-Mortem 

permission of relatives for 108 

Pregnancy 

abdominal 49 

appendicitis in 35 

carcinoma in 44 

cholecystitis in 35 

disturbance of 25 

extrauterine 48 

interference with 28 

intestinal obstruction in 35 

medical treatment in 33 

operative treatment in 34 

ovarian 49 

treatment in tubal 50 

tubal 48 

Pyelitis 27 

Pyosalpinx 

ectopic gestation 50 



Q 

Quinine 

use of in malaria 34 

in influenza 34 



R 

Radium 

and cancer 47 

and sterilization 5$ 

Race Suicide 69 

Religion 

consolations of 101 



134 INDEX 

Reproductive Organs page 

illicit operations on 57 

licit operations on 36, 57 

Responsibility 

in illicit operations 60 

nature of 14 

requisites for 16 

Right 

nature of 5 

objects of 6 

of State 7 

spiritual 65 

to life, qualities of 6 



S 

Sacraments 

administration of 101 

external preparation for 113 

Last 101 

and duty of Catholics 101 

and doctor and nurse 101 

Salpingectomy 

illicitness of 57 

Science 

Moral, on life 10 

Section 

Caesarean 37, 98 

Sickness 

and calling friends 65 

and calling priest 101 

Sterilization 

illicitness of 57 

radium for 58 

X-ray for 58 



T 

Toxemia 

in ectopic gestation 52 

species of 26 



INDEX 135 

Tuberculosis page 

and abortion 26 

Tumor 

carcinoma 44 

fibromyoma 42 

gangrenous 44 

in ectopic gestation 50 

intra-mural « 42 

ovarian 35, 50 

sub-mucous 42 

enucleation of 43 

sub-serous 42 

tubal 36 

special case of 42 

Twilight Sleep 

medical authorities on 56 

morality of 56 

Typhoid 

and abortion 26 



U 

Uterine Adnexa 

cure of 35 

Uterus 

curettement of 27 

excision of 28 

removal of 58 

rupture of . . . , 38 

incarceration of 36 



V 

Vasectomy 

illicitness of 58 

Viability 

O'Malley on 21 

period of arrival at 22 

Viaticum, Holy 

preparation for 113 



136 INDEX 



w 

Williams page 

on ectopic gestation 49 

on Twilight Sleep 56 

X 

X-RAY 

illicit use of 27 

licit use of 47 

use of, for sterilization, immoral 58 



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